Primary Care Physicians and Specialists Participate in Closing the Referral Loop (CRL) Collaborative

Community-based physicians and cardiologists, along with Wright Center primary care residents and cardiology fellows, have collaborated with the American Medical Association on an 18-month, pilot project to improve timeliness and quality of primary care physician-to-specialist referrals by establishing accountability and improving transfer of information.


The final learning session, concluding the Closing the Referral Loop (CRL) collaborative, was held Thursday, June 4 from 4 p.m. to 9 p.m. at The Commonwealth Medical College (TCMC) in Scranton, Pennsylvania. Twelve pairs (or dyads), comprised of a primary care physician (PCP) and cardiologist, along with their office staff, resident physicians and cardiology fellows, shared their progress and lessons learned while participating in this innovative project. Research posters were displayed and formal presentations began promptly at 5 p.m. Connie Sixta, PhD, Independent Improvement Advisor, Sixta Consulting, and Courtney Dempsey, Clinical Innovation Specialist at The Wright Center, led the event and discussion.


The CRL initiative aims to establish clarity of a PCP’s specific clinical question, ensure thoroughness of the Specialist’s answer and confirm the answer is received by the PCP. Notably, through the pilot program the number of referrals with documented answers from the Specialist increased from 50% to 75% and the number of referrals “closed” in a timely manner increased from 40% to 70% at completion of the first year.

Pictured, L-R: Stephen L. Davidow, MBA-HCM, CPHQ, APR, Project Manager II – Quality Improvement Program, Performance Improvement, American Medical Association (AMA); Brian Ebersole, Senior Vice President of Mission Delivery, The Wright Center; Connie Sixta, RN, MSN, MBA, PhD, Independent Improvement Advisor, Sixta Consulting; Jignesh Sheth, M.D., Senior Vice President for Mission Accountability, The Wright Center; Linda Thomas, M.D., President and CEO, The Wright Center; Courtney Dempsey, Clinical Innovation Specialist, The Wright Center Not pictured: Dana Richardson, RN, MHA, Director, PCPI Operations and Strategic Initiatives, American Medical Association (AMA)

All participating doctors have developed Care Compacts to define specific expectations and provide accountable care for their patients throughout the referral process. Care Compacts also ensure communication with the patient being referred. The Care Compact specifies the established process of electronically posing and answering the clinical question.


The desired result of this initiative is higher satisfaction and understanding of the referral process for patients and physicians. The pilot study used the Institute for Healthcare Improvement’s (IHI) Learning Collaborative Model to test interventions and approaches that have improved the referral process within individual healthcare systems.


“Closing the Referral Loop increased accessibility for patients while building a culture of quality improvement focused on collaborative and patient-centered care to achieve better health for our patients and community. It is gaining national attention as a way to bring value to patients and providers alike and offers the opportunity for providers to have a ‘voice’ in ensuring nationally established Electronic Medical Records Meaningful Use (EMR MU) metrics reflect real value for patients and satisfaction for providers,” said Jignesh Sheth, M.D., MPH, CRL Physician Lead, and Senior Vice President for Mission Accountability at The Wright Center.


Linda Thomas-Hemak, M.D., President and CEO of The Wright Center concluded eloquently with the following reflection, “We need to be really mindful to intentionally ensure that an authentic patient-centered frame of reference is at the heart of all of our innovations in healthcare. Patients’ knowledgeable engagement in the primary care-specialty referral process and true understanding of the clinical question and answer are paramount to effective care delivery and coordination.”

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