Burton, C.D. orcid.org/0000-0003-0233-2431, McLernon, D., Lee, A.J. et al. (1 more author) (2017) Distinguishing variation in referral accuracy from referral threshold: analysis of a national dataset of referrals for suspected cancer. BMJ Open, 7. e016439. ISSN 2044-6055
Abstract
Objectives: To distinguish between variation in referral threshold and variation in accurate selection of patients for referral in fast-track referrals for possible cancer. To examine factors associated with threshold and accuracy and model the effects of changing thresholds.
Design: Analysis of national data on cancer referrals from general practices in England over a five-year period. We developed a new method to estimate specificity of referral to complement existing sensitivity. We used bivariate meta-analysis to produce summary measures and described practices in relation to these.
Setting: 5479 GP practices with data relating to more than 50 cancer cases diagnosed over the five years.
Outcomes: Number of practices whose 95% confidence regions for sensitivity and specificity indicated that they were outliers in terms of either referral threshold or decision accuracy.
Results: 2019 practices (36.8%) were outliers in relation to referral threshold compared to 1205 practices (22.0%) in relation to decision accuracy. Practice age profile, cancer incidence, and deprivation showed a modest association with decision accuracy but not with thresholds. If all practices shared the referral behaviour of those in the highest quintile of age-standardised referral rate there would be a 3.3% increase in cancers detected through fast track pathways at the cost of a 36.9% increase in urgent referrals.
Conclusion: This new method permits variation in referral to be described more precisely and quality improvement activities to be targeted. Changing referral thresholds without increasing accuracy will result in modest effects on detection rates and a large increase in demand on diagnostic services.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
Keywords: | Cancer; General Practice; Primary Care; Referral; Variation; Bivariate metaanalysis |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > The Medical School (Sheffield) |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 01 Aug 2017 12:02 |
Last Modified: | 24 Jan 2020 11:45 |
Published Version: | https://doi.org/10.1136/bmjopen-2017-016439 |
Status: | Published |
Publisher: | BMJ Journals |
Refereed: | Yes |
Identification Number: | 10.1136/bmjopen-2017-016439 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:119694 |