TY - JOUR
KW - consultation
KW - Referrals
KW - relationships
KW - specialty care
KW - vertical integration
AU - A. D. Schreiner
AU - K. T. Holmes-Maybank
AU - J. Zhang
AU - J. Marsden
AU - P. D. Mauldin
AU - W. P. Moran
A1 - 
AB - Introduction: Primary care referrals to specialty physicians once relied upon the medical skill of the specialist, the quality of past communication, and previous consultative experiences. As health systems vertically integrate, patterns of specialty physician referral designation are not known. Methods: This cross-sectional study from a patient-centered medical home (PCMH) evaluated the proportion of referrals with named specialists. All outpatient specialty referrals from the PCMH between July and December of 2014 were eligible for inclusion, and 410 patients were randomly selected for chart review. The outcome of interest was specialty physician designation. Other variables of interest included PCMH provider experience, the reason for referral, and time to specialty visit. Univariate analysis was performed with Fisher exact tests. Results: Of 410 specialty referrals, 43.7% were made to medical specialties, 41.7% to surgical specialties, and 14.6% to ancillary specialties. Resident physicians placed 224 referrals (54.6%), faculty physicians ordered 155 (37.8%), and advanced practice providers ordered 31 (7.6%). Only 11.2% of the specialty referral orders designated a specific physician. No differences appeared in the reason for referral, the referral destination, the proportion of visits scheduled and attended, or the time to schedule between those referrals with and without specialty physician designation. Faculty physicians identified a specific specialist in 21.4% of referrals compared to residents doing so in 4.9% (P < .0001). Conclusion: Patient-centered medical home referrals named a specific specialty physician infrequently, suggesting a shift from the historical reliance on the individual characteristics of the specialist in the referral process.
AD - Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.; Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.; Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.; Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.; Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.; Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
BT - Health services research and managerial epidemiology
C5 - Medical Home
CY - United States
DO - 10.1177/2333392819850389
JF - Health services research and managerial epidemiology
M1 - Journal Article
N2 - Introduction: Primary care referrals to specialty physicians once relied upon the medical skill of the specialist, the quality of past communication, and previous consultative experiences. As health systems vertically integrate, patterns of specialty physician referral designation are not known. Methods: This cross-sectional study from a patient-centered medical home (PCMH) evaluated the proportion of referrals with named specialists. All outpatient specialty referrals from the PCMH between July and December of 2014 were eligible for inclusion, and 410 patients were randomly selected for chart review. The outcome of interest was specialty physician designation. Other variables of interest included PCMH provider experience, the reason for referral, and time to specialty visit. Univariate analysis was performed with Fisher exact tests. Results: Of 410 specialty referrals, 43.7% were made to medical specialties, 41.7% to surgical specialties, and 14.6% to ancillary specialties. Resident physicians placed 224 referrals (54.6%), faculty physicians ordered 155 (37.8%), and advanced practice providers ordered 31 (7.6%). Only 11.2% of the specialty referral orders designated a specific physician. No differences appeared in the reason for referral, the referral destination, the proportion of visits scheduled and attended, or the time to schedule between those referrals with and without specialty physician designation. Faculty physicians identified a specific specialist in 21.4% of referrals compared to residents doing so in 4.9% (P < .0001). Conclusion: Patient-centered medical home referrals named a specific specialty physician infrequently, suggesting a shift from the historical reliance on the individual characteristics of the specialist in the referral process.
PP - United States
PY - 2019
SN - 2333-3928; 2333-3928
SP - 2333392819850389
EP - Dec
EP - 
T1 - Specialty Physician Designation in Referrals from a Vertically Integrated PCMH
T2 - Health services research and managerial epidemiology
TI - Specialty Physician Designation in Referrals from a Vertically Integrated PCMH
U1 - Medical Home
U2 - 31205980
U3 - 10.1177/2333392819850389
VL - 6
VO - 2333-3928; 2333-3928
Y1 - 2019
Y2 - May 23
ER -