• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of hsresearchLink to Publisher's site
Health Serv Res. Apr 1999; 34(1 Pt 2): 323–329.
PMCID: PMC1089004

Variations in primary care physician referral rates.

Abstract

OBJECTIVE: To examine primary care physician referral rate variations, including their extent and their stability over time and across diagnostic categories. DATA SOURCES: 1995/1996 claims data for adult patients from a large Independent Practitioner Association (IPA) model managed care organization (MCO) in the Rochester, NY metropolitan area. The IPA includes over 95 percent of area primary care physicians (PCPs), and the MCO includes over 50 percent area residents. STUDY DESIGN: Referral rates (patients referred to and seen by specialists one or more times/patients seen by PCP/year) were developed for the PCPs (457 general practitioners, family physicians, and internists) in the MCO, including observed referral rates, expected referral rates based on case-mix adjustment across the whole sample, physician-specific case mix-adjusted referral rates (empirical Bayes estimates), and diagnostic category-specific case mix-adjusted referral rates. PRINCIPAL FINDINGS: Wide variations in observed referral rates (0.01-0.69 patients referred/patients seen/year) were attenuated relatively little by case-mix adjustment and persisted in case mix-adjusted empirical Bayes estimates (0.02-0.65). The year-to-year case mix-adjusted referral rate correlation was .90. Correlations of case mix adjusted-referral rates across diagnostic categories were moderate (r=.46-.67). CONCLUSIONS: PCP referral rates exhibit wide variations that are independent of case mix, remain stable over time, and are generalizable across diagnostic categories. Understanding this physician practice variation and its relationship to costs and outcomes is critical to evaluating the effect of current efforts to reduce PCP referral rates.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (682K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Calman NS, Hyman RB, Licht W. Variability in consultation rates and practitioner level of diagnostic certainty. J Fam Pract. 1992 Jul;35(1):31–38. [PubMed]
  • Franks P, Clancy CM. Referrals of adult patients from primary care: demographic disparities and their relationship to HMO insurance. J Fam Pract. 1997 Jul;45(1):47–53. [PubMed]
  • Franks P, Clancy CM, Nutting PA. Defining primary care. Empirical analysis of the National Ambulatory Medical Care Survey. Med Care. 1997 Jul;35(7):655–668. [PubMed]
  • Glenn JK, Lawler FH, Hoerl MS. Physician referrals in a competitive environment. An estimate of the economic impact of a referral. JAMA. 1987 Oct 9;258(14):1920–1923. [PubMed]
  • Greenfield S, Nelson EC, Zubkoff M, Manning W, Rogers W, Kravitz RL, Keller A, Tarlov AR, Ware JE., Jr Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study. JAMA. 1992 Mar 25;267(12):1624–1630. [PubMed]
  • Kassirer JP. Access to specialty care. N Engl J Med. 1994 Oct 27;331(17):1151–1153. [PubMed]
  • Moore AT, Roland MO. How much variation in referral rates among general practitioners is due to chance? BMJ. 1989 Feb 25;298(6672):500–502. [PMC free article] [PubMed]
  • Nutting PA, Franks P, Clancy CM. Referral and consultation in primary care: do we understand what we're doing? J Fam Pract. 1992 Jul;35(1):21–23. [PubMed]
  • Roland MO, Green CA, Roberts SO. Should general practitioners refer more patients to hospital? J R Soc Med. 1991 Jul;84(7):403–404. [PMC free article] [PubMed]
  • Salem-Schatz S, Moore G, Rucker M, Pearson SD. The case for case-mix adjustment in practice profiling. When good apples look bad. JAMA. 1994 Sep 21;272(11):871–874. [PubMed]
  • Shortell SM, Vahovich SG. Patient referral differences among specialties. Health Serv Res. 1975 Summer;10(2):146–161. [PMC free article] [PubMed]
  • Weiner JP, Starfield BH, Steinwachs DM, Mumford LM. Development and application of a population-oriented measure of ambulatory care case-mix. Med Care. 1991 May;29(5):452–472. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...