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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    • "Although many advocate the need for care coordination[2,12131415, there is little healthcare research examining the evidence-based practices for how successful coordination occurs. To address this gap, we draw on Okhuysen and Bechky's theoretical model of coordination[8]to facilitate the study objectives of characterizing coordination practices and assessing the association of these coordination practices with clinical performance. "
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    ABSTRACT: Background: Team coordination within clinical care settings is a critical component of effective patient care. Less is known about the extent, effectiveness, and impact of coordination activities among professionals within VA Patient-Aligned Care Teams (PACTs). This study will address these gaps by describing the specific, fundamental tasks and practices involved in PACT coordination, their impact on performance measures, and the role of coordination task complexity. Methods/design: First, we will use a web-based survey of coordination practices among 1600 PACTs in the national VHA. Survey findings will characterize PACT coordination practices and assess their association with clinical performance measures. Functional job analysis, using 6-8 subject matter experts who are 3rd and 4th year residents in VA Primary Care rotations, will be utilized to identify the tasks involved in completing clinical performance measures to standard. From this, expert ratings of coordination complexity will be used to determine the level of coordinative complexity required for each of the clinical performance measures drawn from the VA External Peer Review Program (EPRP). For objective 3, data collected from the first two methods will evaluate the effect of clinical complexity on the relationships between measures of PACT coordination and their ratings on the clinical performance measures. Discussion: Results from this study will support successful implementation of coordinated team-based work in clinical settings by providing knowledge regarding which aspects of care require the most complex levels of coordination and how specific coordination practices impact clinical performance.
    Full-text · Article · Dec 2015 · Implementation Science
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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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    Full-text · Article · Feb 2014 · International journal of nursing knowledge
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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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    ABSTRACT: Health care reform in the US has introduced terms such as 'the patient-centered medical home' and 'integrated care' that are often unclear and unfamiliar to patients. This study explored patient experiences with the functional domains of integrated care. Patients first wrote their definitions of integrated care and then participated in focus group discussions about their experiences with the health care system. Transcripts were analyzed for thematic content. Forty-four patients participated in one of seven focus groups in San Francisco, CA in English and Spanish. Many patients were not clear about the meaning of the term integrated care. However, patients described experiences largely reflected in an existing conceptual model of integrated care and the importance of coordination within and across teams and with community resources, continuity and sharing of information, and patient engagement. Patients with high medical needs described the ubiquitous challenges they faced in experiencing coordinated care. Patients may not understand the term integrated care but are relatively clear on what the concept of integrated care entails and support its successful implementation. Patients and their families are at the center of integrated care, and health systems need to support and empower them to successfully navigate the medical neighborhood.
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