Chicago: Using Evidence-Based Rules To Make Smarter Referrals

PRACTICE Cook County Safety Net Partnership. WHO AND WHERE Twenty-three organizations providing primary and specialty care to uninsured and Medicaid patients in the Chicago area, including Cook County Health and Hospitals System, community health centers, several community hospitals, and the local health department. CORE INNOVATION Providers use a Web-based system to request referrals to specialists or diagnostic services; specialists and others use the system to refer patients for primary care. A software program applies evidence-based rules to approve, expedite, or deny specialty referrals. Denials can be appealed for clinical review; referrals are tracked electronically, allowing assessment of demand, wait times, and other measures useful for evaluation and planning. KEY RESULTS Referral processing time was reduced from an average of three months to 5.5 days. A total of 23,000 referrals, or 22 percent of total requests, were screened out as inappropriate during the first year of operation. Referral volume is now sevenfold higher than under the previous paper system but is managed by a smaller staff. CHALLENGES Grant funding for the program expired after three years, resulting in a continuing shortage of money and in project delays. The referral system is not yet electronically integrated with other hospital information systems.