Pre-appointment management of new patient referrals in rheumatology: A keystrategy for improving health care delivery

Objective. To analyze the impact of a rheumatologist reviewing each newly r eferred patient's medical records prior to scheduling an appointment (pre-a ppointment management). Methods. All 279 new patients who were referred in the 6 months after initi ating pre-appointment management were studied. The authors reviewed systemw ide patient records, appointment intake information, visit schedules, physi cian comments, and patient complaint data. Results. Only 59% of referred patients required a rheumatology consultation for appropriate care. Some problems were rapidly resolved without consulta tion. In some cases, other specialty consultation or continuing prior care was considered to be more appropriate. The latter alternative did not compr omise these patients' outcomes. Practice access and efficiency were improve d. Profitability was maintained. Referring physicians and patients were gen erally accepting and cooperative. Conclusion. New patient pre-appointment management should be a key strategy for reducing health care costs, addressing personnel shortage, and improvi ng access to and coordination of rheumatic disease care.