Development and testing of an instrument in Western Norway to measure the quality of referral information from primary care to specialised mental health care

Abstract

Introduction

Several studies have indicated that medical referral letters do not convey the necessary information to ensure sufficient coordination of care. However, there is no definition of the core set of information items that should be communicated in a referral process, and no valid measurements to assess, and thus improve, the quality of such information. The present study aimed to develop and test an instrument to measure the quality of referral information provided by general practitioners to specialised mental health care services for adults.

Methods

Based on a recommendation taking the users’ standpoint into account, a minimum set of items for referral communication seen as essential by experienced specialists (N = 42) was developed. An instrument to assess the quality of referral information for specialised mental health care for adults was then examined based on its psychometric properties. The examination was conducted within the region of Western Norway Regional Health Authority (www.helse-vest.no), representing the public specialised mental health care for approximately 1 million citizens.

Results

Nineteen items were recommended, and the instrument was found valid and reliable. The inter-rater correlation varied, and the test–retest was found to be substantial or almost perfect for a majority of the raters.

Discussion

This study embeds an exploration of improvement potential, impact of quality improvement efforts and sustainability of such efforts for facilitating effective communication in the interface between the two main health services for people with mental health problems. Further exploration on the instruments generalisability to other contexts and to the inter-rater correlation are recommended.