physician and educator co-design of a canadian school-based health centre referral form: a quality improvement study

Background: a school-based health centre (sbhc) in toronto, canada, supports students with academic, developmental,and behaviour-related challenges. the educators in this centre complete a referral form to provide information to the sbhc.the present study aimed to a) collaborate with the educators to co-design the existing sbhc referral form and b) provide theeducators with a resource on a common pediatric disorder.methods: the current quality improvement study was performed using a plan-do-study-act (pdsa) cycle. data was collectedfrom november 2020 to january 2021. twenty-three educators rated their understanding of the original sbhc referral formusing a 6-point likert scale. the symptom descriptors flagged by >10% of the educators as unclear were updated and re-evaluatedthrough a second survey. the educators voted on a common medical issue for which a pamphlet was created and evaluated for itseffectiveness. statistical analysis was performed using graphpad prism. paired data were assessed by wilcoxon rank-order test,unpaired data with fischer’s exact, and proportions via chi-squared test.results: the original referral form had 13/48 (27%) presenting symptoms identified for revision. after this revision, significantlyfewer presenting symptoms met the criteria for revision (3/50, 6%; p<0.01). most educators (10/23, 43%) requested aneducational pamphlet on childhood anxiety. the majority of them (13/16, 81%) strongly agreed that they knew more aboutchildhood anxiety after reviewing the resource and all of them (16/16, 100%) thought the resource would be helpful and couldbe shared with parents.conclusion: collaboration with the educators to co-design a sbhc referral form clarified its descriptors, enhancing thecommunication between the two parties in the referral process. physician-created educational resource enhanced the educators’knowledge about anxiety.