BACKGROUND Referral letters from primary care contain a large amount of information that could be used to improve the appropriateness of the referral pathway for individuals seeking specialist opinion for knee or hip pain. The primary aim of this study was to evaluate the content of the referral letters to identify information that can independently predict an optimal care pathway. METHODS Using a prospective longitudinal design, a convenience sample of patients with hip or knee pain were recruited from orthopaedic, specialist general practice and advanced physiotherapy practitioner clinics. Individuals completed a Knee or hip Osteoarthritis Outcome Score at initial consultation and after 6 months. Participant demographics, body mass index, medication and co-morbidity data were extracted from the referral letters. Free text of the referral letters was mapped automatically onto the Unified Medical Language System to identify relevant clinical variables. Treatment outcomes were extracted from the consultation letters. Each outcome was classified as being an optimal or sub-optimal pathway, where an optimal pathway was defined as the one that results in the right treatment at the right time. Logistic regression was used to identify variables that were independently associated with an optimal pathway. RESULTS A total of 643 participants were recruited, 419 (66.7%) were classified as having an optimal pathway. Variables independently associated with having an optimal care pathway were lower body mass index (OR 1.0, 95% CI 0.9 to 1.0 p = 0.004), named disease or syndromes (OR 1.8, 95% CI 1.1 to 2.8, p = 0.02) and taking pharmacologic substances (OR 1.8, 95% CI 1.0 to 3.3, p = 0.02). Having a single diagnostic procedure was associated with a suboptimal pathway (OR 0.5, 95% CI 0.3 to 0.9 p < 0.001). Neither Knee nor Hip Osteoarthritis Outcome scores were associated with an optimal pathway. Body mass index was found to be a good predictor of patient rated function (coefficient - 0.8, 95% CI -1.1, - 0.4 p < 0.001). CONCLUSION Over 30% of patients followed sub-optimal care pathway, which represents potential inefficiency and wasted healthcare resource. A core data set including body mass index should be considered as this was a predictor of optimal care and patient rated pain and function.

中文翻译：

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使用膝盖和髋部疼痛患者的常规转诊数据来改善获得专科护理的机会。

背景技术来自初级保健的转诊信包含大量信息，这些信息可用于改善对膝盖或髋部疼痛寻求专业意见的个人的转诊途径的适当性。这项研究的主要目的是评估推荐信的内容，以识别可以独立预测最佳护理途径的信息。方法采用前瞻性纵向设计，从整形外科，专科普通实践和高级物理治疗医师诊所招募了髋关节或膝关节疼痛患者的便利样本。在初次咨询时和6个月后，个体完成了膝盖或髋关节骨关节炎的结果评分。从推荐信中提取出参与者的人口统计学，体重指数，药物和合并症数据。推荐信的自由文本自动映射到统一医学语言系统上，以识别相关的临床变量。治疗结果摘自咨询信。每种结果均被归类为最佳或次优途径，其中最佳途径定义为在正确的时间进行正确治疗的途径。使用逻辑回归来确定与最佳途径无关的变量。结果共招募了643名参与者，其中419名（66.7％）被归类为最佳途径。与拥有最佳护理途径独立相关的变量是较低的体重指数（OR 1.0，95％CI 0.9至1.0 p = 0.004），被称为疾病或综合症（OR 1.8，95％CI 1.1至2.8，p = 0.02）并采取药理物质（OR 1.8，95％CI 1。0至3.3，p = 0.02）。单一诊断程序与次优途径相关（OR 0.5，95％CI 0.3至0.9 p <0.001）。膝关节和髋关节骨关节炎的结果评分均与最佳途径无关。发现体重指数是患者额定功能的良好预测指标（系数-0.8，95％CI -1.1，-0.4 p <0.001）。结论超过30％的患者遵循了次优护理途径，这表示潜在的低效率和浪费的医疗资源。应该考虑包括体重指数在内的核心数据集，因为这是最佳护理和患者额定疼痛与功能的预测指标。膝关节和髋关节骨关节炎的结果评分均与最佳途径无关。发现体重指数是患者额定功能的良好预测指标（系数-0.8，95％CI -1.1，-0.4 p <0.001）。结论超过30％的患者遵循了次优护理途径，这表示潜在的低效率和浪费的医疗资源。应该考虑包括体重指数在内的核心数据集，因为这是最佳护理和患者额定疼痛与功能的预测指标。膝关节和髋关节骨关节炎的结果评分均与最佳途径无关。人们发现，体重指数可以很好地预测患者的额定功能（系数-0.8、95％CI -1.1，-0.4 p <0.001）。结论超过30％的患者遵循了次优护理途径，这表示潜在的低效率和浪费的医疗资源。应该考虑包括体重指数在内的核心数据集，因为这是最佳护理和患者额定疼痛与功能的预测指标。