Table 3.
Study outcomes
| Study | Kirkpatrick level | Outcome details |
|---|---|---|
| Electronic referrals | ||
| Shaw and de Berker (2007) | 3 | ERs showed communication of the patient’s problem by GPs was poor |
| Kim et al. (2009) | 4 | 72% believed that ERs improved overall clinical care of patients but the study population was a mixture of physicians, many were specialists and the study setting is not representative of typical general practice |
| Nash et al. (2016) | 3 | ERs provided more clinical information than handwritten but no effect on patient or system outcomes |
| Hysong et al. (2011) | NA | Improvement in referral coordination by PCPs and subspecialists |
| Zuchowski et al. (2015) | NA | Improvement in referral communication |
| Peer feedback | ||
| Evans (2009) | 4 | Improvement in referral quality and reducing inappropriate demand |
| Xiang et al. (2013) | 3 | Improvement in referral quality and decisions made will be more accurate |
| Elwyn et al. (2007) | 3 | Improving the quality of referrals and reducing demand |
| Templates | ||
| Haley et al. (2015) | 3 | Improvement in documentation |
| Rokstad et al. (2013) | 4 | Improvement in referral quality and in time efficiency by the specialist reviewing the letters |
| Wahlberg et al. (2015) | 3 | Improvement in documentation |
| Wahlberg et al. (2016) | 3 | Sought to prove association with patient experience compared with control but none seen |
| Wahlberg et al. (2017) | 3 | Sought to prove association with improved quality of care through quality indicators but none seen |
| Eskeland et al. (2017) | 3 | Improvement in referral quality |
| Jiwa et al. (2014) | 3 | Improvement in documentation of clinically relevant data. Referral times unchanged. Preference for free script |
| Jiwa and Dhaliwal (2012) | 3 | Improvement in referral quality as judged by specialists. No improvement in ability to identify high-risk patients |
| Mixed interventions | ||
| Wright et al. (2015) | 4 | Improvement in referral quality and reduced number of inappropriate referrals. Reduced number of referrals |
| Corwin and Bolter (2014) | 3 | Combination of peer feedback and electronic referrals. Referral quality was only seen with peer feedback |
ER=electronic referral; PCP=primary care provider.