Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Monitoring Referrals to Strengthen Service Integration


Published on

Presented by Dr. Cristina de la Torre for a November 2013 webinar.

Access the webinar recording at

Published in: Technology, Business
  • Be the first to comment

Monitoring Referrals to Strengthen Service Integration

  1. 1. Monitoring referrals to strengthen service integration Cristina de la Torre, MPH, DSc. MEASURE Evaluation/ICF International
  2. 2. Health services integration Objectives  Improve efficiency, reduce costs  Increase access to and coverage of services  Increase use of wider range of services  (e.g. minimum package of services)  Meet diverse health needs of clients  Improve health outcomes
  3. 3. Models of integration 1. Single provider – multiple services 2. Multiple services on site – different providers 3. Linking services across sites
  4. 4. Components of an effective referral system  Group of organizations providing comprehensive range of services within a defined geographic region  Directory of services & providers  Referral protocols  Processes to facilitate referral completion  Information exchange across providers, including feedback loop  Tracking of referrals (standardized registers, client referral forms)  Coordinating unit Adapted from: FHI 2005
  5. 5. Referral systems
  6. 6. Specify the referral system of interest  Nature of system to be studied  Program(s) included  Geographic coverage  Organizations  Range of services offered  Referral systems vs referral networks
  7. 7. Referral Assessment and Monitoring (RSAM) Toolkit Provide tools and guidance for studying the performance of referral system  Assess overall functioning of the referral system  Establish a routine monitoring system of referrals  Adapt tools, gather, analyze and interpret data on referral system performance
  8. 8. Considerations  Flexibility: Adaptable to  Different programs & types of services  Structure of referral systems  Limit burden of data collection  Use data commonly collected by service providers  User-friendly
  9. 9. RSAM Toolkit Components  Referral system assessment (RSA)  In-depth examination of processes and mechanisms at given point in time  Referral system monitoring (RSM)  Routine data to track levels of referral initiation and completion across services
  10. 10. RSAM TOOLKIT Referral System Assessment Focus on processes and systems  How the referral system is structured  How networks are formed  Whether written referral protocols and guidelines exist  The processes providers follow to refer and counter-refer clients  How well referrals are tracked and followed up  Barriers to referral initiation and referral completion
  11. 11. Referral System Assessment  Provides a snapshot of the referral system at a given point in time  Can be used to evaluate changes in performance if applied repeatedly  Evaluate effectiveness of interventions
  12. 12. Referral System Assessment Tools:  RSA Questionnaire  Document Checklist  RSA Analysis Guide  Decision Calendar
  13. 13. Referral System Assessment Other information provided in toolkit:  Who should implement an RSA  Resources needed  Selecting facilities  Adapting instruments  Guidelines for analysis  How and why to involve stakeholders
  14. 14. RSAM TOOLKIT Referral System Monitoring Routine data from facilities  How often referrals are made to different services?  What types of services are clients most often referred to?  Are clients able to take advantage of the referrals?  Is adequate follow-up provided after the fact?  Are referrals equitable across gender or age groups?
  15. 15. Referral system monitoring Key indicators:  Referral initiation % clients referred from service A to service B  Referral completion % of referred clients who complete referral  Counter-referral % of clients who complete referral who are seen again by initiating provider
  16. 16. Monitoring Adapting tools  What level of disaggregation do you need:  Specificity of services  Sub-populations
  17. 17. Referral systems
  18. 18. (TO BE COMPLETED BY REFERRING SERVICE) PAGE 1 of 3 Name of organization and facility: _____________________________________ Geographic unit: _______________________________ Reporting period—Month: ______ Year: __________ Prepared by: ________________________ 1. Number of clients referred by type of service Group for which data are reported—Age range: _______________ Sex: ______________ COLUM NY REFERRING SERVICE Service 1 (FP) Service 2 (VCT) Service 3 (STI) Service 4 (ART) Service 5 Service 6 TOTAL NUMBER CLIENTS SEEN AT REFERRING SERVICE CLIENTS REFERRED TO RECEIVING SERVICES Service 1 (FP) Service 2 (VCT) Service 3 (STI) Service 4 (ART) Service 5 Service 6
  19. 19. Indicator Reporting Form Geographic unit: _____________________Region: _____________________________________ Reporting period—Month: _______ Year: _________Prepared by: _________________________ Group for which data are reported—Age range: _______________ Sex: ______________ Referring Service Receiving Service Service 1 Service 1 Service 1 Service 2 Service 2 Service 2 Service 3 Service 3 Etc. Service 2 Service 3 Service 4 Service 1 Service 3 Service 4 Service 1 Service 2 Etc. Indicator 1: Proportion of clients referred from initiating service Indicator 2: Indicator 3: Proportion of Proportion of referred clients referred clients that completed seen at receiving referral at service that is seen receiving facility back at referring service for counterreferral
  20. 20. Illustrative monitoring data
  21. 21. Illustrative data
  22. 22. Benefits of monitoring and assessing referrals Aid in Identifying:  under or over-utilized services  providers who are not referring patients  access or quality issues that impede service utilization  linkages between services that are not sufficiently established Aid in planning, resource allocation
  23. 23. Referral System Assessment and Monitoring (RSAM) Toolkit (MEASURE Evaluation)
  24. 24. The research presented here has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement GHA-A-00-08-0000300. Views expressed are not necessarily those of PEPFAR, USAID or the United States government. MEASURE Evaluation is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill in partnership with Futures Group, ICF International, John Snow, Inc., Management Sciences for Health, and Tulane University.