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Development and validation of a tool to improve paediatric referral/consultation communication
  1. Christopher J Stille1,
  2. Kathleen M Mazor2,3,
  3. Vanessa Meterko3,
  4. Richard C Wasserman4
  1. 1Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
  2. 2Department of Medicine, Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  3. 3Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  4. 4Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont, USA
  1. Correspondence to Dr Christopher Stille, University of Colorado/The Children's Hospital, 13123 East 16th Avenue, B032, Aurora, CO 80045, USA; stille.christopher{at}


Objective To develop a template to promote brief but high-quality communication between paediatric primary care clinicians and consulting specialists.

Methods Through an iterative process with academic and community-based paediatric primary care providers and specialists, the authors identified what content elements would be of value when communicating around referrals. The authors then developed a one-page template to encourage both primary care and specialty clinicians to include these elements when communicating about referrals. Trained clinician reviewers examined a sample of 206 referrals from community primary care providers (PCPs) to specialists in five paediatric specialties at an academic medical centre, coding communication content and rating the overall value of the referral communication. The relationship between the value ratings and each content element was examined to determine which content elements contributed to perceived value.

Results Almost all content elements were associated with increased value as rated by clinician reviewers. The most valuable communications from PCP to specialist contained specific questions for the specialist and/or physical exam features, and the most valuable from specialist to PCP contained brief education for the PCP about the condition; all three elements were found in a minority of communications reviewed.

Conclusions A limited set of communication elements is suitable for a brief communication template in communication from paediatric PCPs to specialists. The use of such a template may add value to interphysician communication.

  • Referral and consultation
  • communication
  • medical home
  • primary care
  • hand-off

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  • Funding This work was supported in part by a grant from the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program (#42206).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the University of Massachusetts Medical School and the Fallon Clinic.

  • Provenance and peer review Not commissioned; externally peer reviewed.