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Enhancing continuity of information: essential components of a referral document


Objective — To identify elements of data that have been shown to contribute to continuity of information between primary care providers and medical specialists providing care to adult asthma patients.

Design — Systematic review of the literature followed by a 2-round modified Delphi consensus process.

Setting — Province of Ontario.

Participants — Eight expert panelists, including 3 practising family physicians, a medical specialist knowledgeable in the treatment of asthma, a family physician previously involved in provincial initiatives related to primary care reform, an e-health technologist, a developer of evidence-based guidelines, and an operations and programs specialist.

Method — We completed a systematic literature review to develop a list of items or data elements related to patient information transfer in chronic care. We engaged an 8-member expert panel in a 2-round modified Delphi process to assess the importance of the 74 data elements identified in the literature review and to identify any additional important elements.

Main Findings — The expert panelists reached consensus on 24 components of information, referred to here as minimum essential elements of a referral document, needed for consultations on adult asthma patients.

Conclusion — The 24 minimum essential elements of information that should be transferred during referral of asthma patients from primary care providers to experts in asthma care were generated by primary care physicians and thought essential for achieving continuity in information transfer. We assembled these elements into a suggested format for a referral document. The format can be easily modified by practitioners caring for patients with other chronic diseases.



Berta W, Barnsley J, Bloom J, Cockerill R, Davis D, Jaakkimainen L, Mior AM, Talbot Y, Vayda E. Can Fam Physician. 2008; 54(10):1432-3.e6.

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Contributing ICES Scientists