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Table 1 Metric Domains, Sub-domains, and Exemplary Metrics

From: Performance measures of the specialty referral process: a systematic review of the literature

Domain Sub-domains # Metrics Metric Example
Evaluation of Need for Specialty Care (n = 14) Referral Source 14 Proportion of self-referred visits [38]
  Referral Decision 0  
Referral Initiation (n = 73) Reason for referral 4 Proportion of referrals for advice on diagnosis and treatment [3]
  Specialist selection 27 Proportion of PCPs who referred at patient request [39]
  Referral rate 42 # Referrals to a specialist per 100 PCP visits [40]
Entry into Specialty Care (n = 53) Attendance 7 Proportion of referred patients who attended first specialty visit [41]
  Accessibility 46 Total # providers per 100,000 people per state [42]
Coordination (n = 60) Communication 48 Proportion of specialist reports by letter or e-mail [43]
  Integration of care 17 Proportion of PCPs who received feedback from a specialist [43]
Referral Type (n = 3) Consultation 3 Proportion of referrals for procedural consultation [44]
  Co-management 3 Proportion of referrals for co-management with shared care [44]
Clinical Tasks (n = 19) Problem recognition 10 Proportion of letters including a patient's condition [45]
  Diagnosis 18 Proportion of letters including a patient's diagnosis [45]
  Treatment 17 Proportion of letters including treatment recommendation [45]
  Reassessment 12 Proportion of letters including follow-up arrangements [45]
Resource Use (n = 13) Services 12 Primary and specialty visits per patient per 30 days [46]
  Costs 13 Total annual specialty expenditures [47]
Quality (n = 57) Appropriateness 13 Proportion of patients who received an unnecessary referral [48]
  Effectiveness 4 Proportion of PCPs who adhered to a specialists' recommendations [49]
  Efficiency 1 Proportion of PCPs who believed a specialist was minimizing costs [50]
  Equity 0  
  Patient-centeredness 8 Proportion of patients who thought that specialty care was helpful[51]
  Referral satisfaction 21 Proportion of patients who were satisfied with specialty care [52]
  Safety 0  
  Timeliness 23 Average length of time spent for a specialty visit [53]
Outcomes (n = 9) Health status 3 Change in depression score on Hopkins Symptom Checklist [54]
  Mortality 2 Proportion of surviving patients per year [55]
  Functional status 3 Change in score on Pain Interference Scale [56]
  Unintended Consequences 0