Referral Management Initiative: An approach to improve and coordinate access to specialty care in a community health center serving public housing recipients

Community health centers provide much needed primary care services to public housing residents. In this setting, specialty care needs, both psychosocial and medical, are often identified. However, this population faces numerous barriers to accessing specialty care, including transportation, language and culture, insurance status, and long waiting periods between referral and scheduled specialty care appointments.

The South Bronx Health Center for Children and Families (SBHCCF) provides comprehensive primary care in an underserved community. Approximately 65% of SBHCCF patients live in public housing. The Referral Management Initiative (RMI) was launched in 1997 to improve access to specialty care. RMI's Family Health Workers coordinate specialty referrals by scheduling appointments on behalf of patients. This coordination is particularly helpful in cases of multi-specialty referrals as is often needed in this high-risk population. Transportation, mostly by mass transit, ambulette or car service, is also arranged by RMI staff to facilitate appointment adherence. Additionally, RMI completes the referral loop by ensuring that SBHCCF providers receive feedback on specialty consults. A proprietary web-based tracking database plays a pivotal role in coordinating these support services.

In 2007, RMI facilitated 3,439 referrals and arranged 5,199 two-way transportation services, which resulted in 4,553 medical specialty appointments for SBHCCF patients. Over a three-year period, patients' likelihood of keeping appointments continuously increased from 59% in 2005, to 61% in 2006, and 63% in 2007. Prior to the implementation of RMI, adherence with specialty appointments was approximately 7%.