Coordination of Specialty Referrals and Physician Satisfaction With Referral Care

Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA.
Archives of Pediatrics and Adolescent Medicine (Impact Factor: 5.73). 06/2000; 154(5):499-506. DOI: 10.1001/archpedi.154.5.499
Source: PubMed


To describe how physicians coordinate patient care for specialty referrals and to examine the effects of these activities on referring physicians' satisfaction with the specialty care their patients receive and referral completion.
Prospective study of a consecutive sample of referrals (N = 963) made from the offices of 122 pediatricians in 85 practices in a national practice-based research network. Data sources included a physician survey completed when the referral was made (response rate, 99%) and a physician survey and medical record review conducted 3 months later (response rate, 85%). Referral completion was defined as receipt of written communication of referral results from the specialist.
Pediatricians scheduled appointments with specialists for 39.3% and sent patient information to specialists for 50.8% of referrals. The adjusted odds of referral completion were increased 3-fold for those referrals for which the pediatrician scheduled the appointment and communicated with the specialist compared with those for which neither activity occurred. Referring physicians' satisfaction ratings were significantly increased by any type of specialist feedback and were highest for referrals involving specialist feedback by both telephone and letter. Elements of specialists' letters that significantly increased physician ratings of letter quality included presence of patient history, suggestions for future care, follow-up arrangements, and plans for comanaging care; only the inclusion of plans for comanaging patient care was significantly related to the referring physicians' overall satisfaction.
Better coordination between referring physicians and specialists increases physician satisfaction with specialty care and enhances referral completion. Improvements in the referral process may be achieved through better communication and collaboration between primary care physicians and specialists.

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    • "In fact, it leads to facilitating appropriate care for patients. Results of various studies show that shortcomings in team coordination lead to serious concerns about achieving quality of care (Forrest et al., 2000; Gandhi, 2005). Audet, Davis, and Schoenbaum (2006) show that the problem of poor coordination within the healthcare team causes numerous health problems for patients, such as delayed discharge or failure to receive essential information in a timely fashion. "
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    • "Our study also indicates that the domains of integrated care and primary care are complementary. Most of the domains that patients described as important for integrated care, including continuity, coordination, access, and comprehensive services, are also core domains of primary care [13–17]. In essence, our study suggests that integrated care can be conceptualized as a health systems property and primary care as a key component of that system. "
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    • "Successful referrals require considerable coordination and interactive communication among the primary care provider (PCP), the subspecialist, and the patient, which may be challenging in the outpatient setting [1-3]. Several studies at the interface of primary and subspecialty care [4-9] suggest poor referral coordination and communication as an important contributor to delays in care,[10,11] mainly due to inappropriate timing and detail of information [12] and lost paperwork. "
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