Specialty referral completion among primary care patients: results from the ASPN Referral Study.
OBJECTIVE
This study describes referral completion from the perspectives of patients and primary care physicians and identifies predictors of adherence to the referral recommendation.


METHODS
We observed a cohort of 776 referred patients from the offices of 133 physicians in 81 practices and 30 states. Referring physicians and patients completed self-administered questionnaires at the time of the referral decision and 3 months later.


RESULTS
Physicians reported that 79.2% of patients referred had a specialist visit, and 83.0% of patients indicated they completed the referral. The most common reasons for not completing the referral were "lack of time" and patient belief that the "health problem had resolved." The kappa statistic for patient-physician agreement on referral completion was 0.34, indicating only fair concordance. Patients in Medicaid plans were less likely than others to complete the referral, and more likely to experience a health plan denial. A longer duration of the patient relationship with the primary care physician and physician/staff scheduling of the specialty appointment were both positive predictors of referral completion.


CONCLUSIONS
About 8 in 10 patients referred from primary care complete a specialty referral within 3 months. Findings from this study suggest that referral completion rates may be increased by assisting patients with scheduling their specialty appointments and promoting continuity of care.
Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. forrestc@email.chop.edu
Christopher B
CB
Forrest
Efrat
E
Shadmi
Paul A
PA
Nutting
Barbara
B
Starfield
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001071:Appointments and Schedules; D002648:Child; D002675:Child, Preschool; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007357:Insurance, Physician Services / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013038:Specialization; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States