title: Does a reduction in general practitioners' use of diagnostic tests lead to more hospital referrals?
abstract: BACKGROUND
  Individual feedback on general practitioners' requests for tests can improve the quality of their test ordering behaviour. Little is known of the side effects on hospital referral behaviour when the use of tests is reduced through feedback.
  
  
  OBJECTIVE
  A study was undertaken to explore changes in general practitioners' hospital referral rates in a region where their use of diagnostic tests is reduced through feedback.
  
  
  METHODS
  Trends in test requests and of first referrals to specialists were compared among 64 general practitioners in the Maastricht region of the Netherlands where routine feedback on test ordering behaviour is provided by the diagnostic coordinating centre.
  
  
  RESULTS
  Reduction in diagnostic test use was not accompanied by a higher hospital referral rate, not even for specialties related to tests discussed in feedback. Good responders to feedback had decreased hospital referral rates in contrast to increased rates for poor responders (P < 0.01).
  
  
  CONCLUSIONS
  Reducing the volume of general practitioners' diagnostic tests through feedback does not lead to more specialist referrals. Together with lower test use, fewer hospital referrals were seen.
authors.affiliation: Diagnostic Coordinating Centre, Maastricht, Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: Winkens
authors.forename: R P
authors.initials: RP
authors.lastname: Grol
authors.forename: G H
authors.initials: GH
authors.lastname: Beusmans
authors.forename: A D
authors.initials: AD
authors.lastname: Kester
authors.forename: J A
authors.initials: JA
authors.lastname: Knottnerus
authors.forename: P
authors.initials: P
authors.lastname: Pop
mesh_terms: D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data*; D006801:Humans; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016526:Workload