[Proposal of a patient reverse referral preference scale for regional medical collaboration]

Objectives　Regional medical collaborations have become increasingly important in recent years. To facilitate such collaborations, it is necessary to promote reverse referrals from large hospitals to clinics. This study aimed to identify the factors that constitute patient preferences regarding reverse referrals and propose a new patient reverse referral preference scale based on the guidelines of the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN).Methods　Seven specialists developed a pool of items that related to preferences for reverse referrals. Patients aged 20 years and older who had been hospitalized in university hospitals or other large hospitals (with 400 beds or more) within the past six months and who were currently receiving treatment for their condition were included in the study. The factor structure that constituted patient reverse referral preferences was determined using an online questionnaire and an exploratory factor analysis. A new scale for assessing patient reverse referral preferences was developed using the factors identified as subscales, and the reliability and validity of the scale were examined.Results　Screening surveys were conducted on 23,000 registered members of an internet survey panel, of whom 374 met the criteria for this study and 293 responded to the survey. The factor analysis identified four factors related to patient preferences for reverse referrals: "evaluation of primary care physicians," "reverse referral acceptability," "treatment continuity," and "disease assessment." Based on these factors, we created a 19-item scale, "The 19-item Patient Preference Questionnaire Form for Reverse Referral (PQR-19)." Cronbach's alpha coefficients for each subscale indicated sufficient reliability (0.76 to 0.87). In terms of validity, patients who accepted reverse referrals at physician recommendation had significantly higher scores on the PQR-19 total score (3.28 ± 0.69 vs. 2.96 ± 0.63, P = 0.044) and its subscale, treatment continuity (3.52 ± 0.76 vs. 3.05 ± 0.81, P = 0.012), and tended to have higher scores on other subscales, compared to those who did not accept reverse referrals.Conclusion　This study identified four factors that constituted patient preferences for reverse referrals through a factor analysis and proposed a new scale, PQR-19. Some aspects of the scale's reliability and validity have not yet been fully verified, which remains a topic for future research.