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First quality score for referral letters in gastroenterology-a validation study
Sigrun Losada Eskeland1, Cathrine Brunborg2, Birgitte Seip3
1Department of Medical Research, Vestre Viken Hospital Trust Bærum, Drammen, Norway.
Objective:
To create and validate an objective and reliable score to assess referral quality in gastroenterology.
Design:
An observational multicentre study.
Setting And Participants:
25 gastroenterologists participated in selecting variables for a Thirty Point Score (TPS) for quality assessment of referrals to gastroenterology specialist healthcare for 9 common indications. From May to September 2014, 7 hospitals from the South-Eastern Norway Regional Health Authority participated in collecting and scoring 327 referrals to a gastroenterologist.
Main Outcome Measure:
Correlation between the TPS and a visual analogue scale (VAS) for referral quality.
Results:
The 327 referrals had an average TPS of 13.2 (range 1-25) and an average VAS of 4.7 (range 0.2-9.5). The reliability of the score was excellent, with an intra-rater intraclass correlation coefficient (ICC) of 0.87 and inter-rater ICC of 0.91. The overall correlation between the TPS and the VAS was moderate (r=0.42), and ranged from fair to substantial for the various indications. Mean agreement was good (ICC=0.47, 95% CI (0.34 to 0.57)), ranging from poor to good.
Conclusions:
The TPS is reliable, objective and shows good agreement with the subjective VAS. The score may be a useful tool for assessing referral quality in gastroenterology, particularly important when evaluating the effect of interventions to improve referral quality.
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