Decision Support:
Establish Linkages with Key Specialists to Assure that Primary Care Providers Have Access to Expert Support
- Find specialists who will treat your patients and support your improvement efforts. (Obtain agreement with specialists to provide data back to the primary care site.)
- Review guidelines with specialists to get their input and buy-in.
- Work with specialists to define appropriate patients for referral, based on the guidelines.
- Work with specialists to clarify the approach to follow-up (i.e., the process for getting information to the primary care provider after the specialist sees the patient).
- Develop a mechanism to track the following:
- Referral made
- Specialist sees patient
- Specialist’s letter received by primary care provider
- Patient returns to primary care provider
- Consider joint visits with specialists or direct phone consultation and other innovative primary care/specialist relationships.
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Seek out institutions with a similar public health mission or teaching institutions, to identify specialists to work with. Teaching hospitals may agree to have residents or fellows rotate through the clinic, who then can help with link to hospital for needed procedures.
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Ask specialists to be part of the team.
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Include specialists in the guideline development process.
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Streamline the process for communication back and forth (e.g., fax-back forms, e-mail, telephone conferences, telemedicine sites). The easier it is, the more likely it will happen.
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Have senior leadership make follow-up between specialty and primary care provider a clear expectation at both locations.
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Designate a specific person to do the tracking and develop a standardized process to track referrals and information from the specialist. If possible, use the registry to track this information.
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Audit 5 to 6 patients periodically to see if the process is working. Be sure to include sociocultural issues in the audit process.
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