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Ana Aguilar Cordova MD

  • Graduate 2018
Scholarly Research Project

Establishing an Efficient Referral System for Well-Child Visits in Rural Honduras

Ana Aguilar, MD; Mark Meyer, MD


For 17 years, the “Shoulder to Shoulder Pittsburgh San Jose” collaborative project annually has provided 1200 well-child visits to children in rural Honduras. Eighty percent of the population lives in poverty and have limited access to medical care. Many children have conditions that require follow-up in the local clinic or referral to a specialist. However, barriers to tracking ongoing care for children have prevented systemic monitoring of referral success. An effective referral system is fundamental for the delivery of care to avoid delay in diagnosis and treatment.


We determined the current referral completion rate and identified ways to improve the referral system by implementing a standardized referral form, and establishing clear communication among all parties.


From 2016-2017, a total of 76 referrals were made using a new standardized referral form. Thirty-nine percent of patients completed their referral. Based on feedback from the local doctor, the new form was easy to understand. 


Although the current system has successfully standardized the referral process, it does not guarantee timely follow-up for non-acute referrals. Demographic and socio-economic factors, including transportation and financial issues, appear to affect compliance.  Further investigation is needed to better understand these barriers. Efforts will be made to ensure appropriate follow-up in subsequent brigades.


Referrals were given previously, but never tracked. The new standardized form was a significant process improvement. The results obtained will serve as a baseline for further studies to continue improving the referral system.