Directing the hospital outpatient to the neighborhood health clinic

Since the hospital is overcrowded and the neighborhood clinics are underutilized, the authors examined the feasibility of changing patients choice of facikity and investigated the effect of such a change on utilization of services. In an earlier study, 84% of patients sampled in the General Medical Clinic were judged by their physicians to be treatable at neighborhood clinics. During the project, however, physicians attempted to refer only about one-half of the patients. This reduction is understandable in that the physicians decision is influenced not only by whether patients will be well served but also by the relationship with the patient and th value of the case for research or teaching. About one-half of the patients to whom referral was proposed gave their consent. Based on the results of this study, administrators of the hospital system are implementing a referral effort on a large scale. A continuing evaluation of this effort is underway to assess the impact of a large redistribution of patients on quality and costs of services and on patients satisfaction.