title: Specialty referral communication and completion in the community health center setting.
abstract: OBJECTIVE
  Parent and provider disagreement about children's care at the time of specialty referral may lead to incomplete referral, ie, not attending a specialty visit when referred. This study's objectives were first to assess parent-provider correlation in perspectives on referral necessity, seriousness of child's health problem, and parental understanding of referral among children referred to pediatric specialists, and second to assess whether these perspectives are associated with incomplete referral.
  
  
  METHODS
  Two months after specialty referral, parents and primary care providers completed a survey rating referral necessity, seriousness of problem, and parental understanding on a 4-part scale ("definitely yes" to "definitely no"). Parents were surveyed by telephone; providers completed one self-administered survey per referral. Using z tests and Pearson correlation coefficients, we summarized parent-provider agreement about referral necessity, seriousness of problem, and parent understanding. We applied logistic regression to test associations of parent and provider ratings for each variable with incomplete referral.
  
  
  RESULTS
  A total of 299 (60.0%) of 498 matched parent and provider surveys were included in the analysis. Parents had low correlation with providers in perspectives of referral necessity and seriousness of problem. Parents reported that referral was necessary more often than providers, and providers underestimated parents' self-reported understanding of the referral. Nearly 1 in 3 children had incomplete referral, and both parent and provider reports of lower necessity were associated with incomplete referral.
  
  
  CONCLUSIONS
  Parents and providers hold divergent perspectives on referral necessity and seriousness of children's health problems; these perspectives may impact rates of incomplete referral. Improving communication around specialty referral might reduce incomplete referral.
authors.affiliation: Oregon Health and Science University, Portland, Ore., USA. zuckerma@ohsu.edu
authors.forename: Katharine E
authors.initials: KE
authors.lastname: Zuckerman
authors.forename: Kerrie
authors.initials: K
authors.lastname: Nelson
authors.forename: Tara K
authors.initials: TK
authors.lastname: Bryant
authors.forename: Karin
authors.initials: K
authors.lastname: Hobrecker
authors.forename: James M
authors.initials: JM
authors.lastname: Perrin
authors.forename: Karen
authors.initials: K
authors.lastname: Donelan
mesh_terms: D002648:Child; D002662:Child Health Services / Q000458:organization & administration; D002669:Child Welfare; D002675:Child, Preschool; D003151:Community Health Centers / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D006801:Humans; D007400:Interprofessional Relations; D016015:Logistic Models; D008297:Male; D008511:Medicine; D020380:Needs Assessment; D010290:Parents; D010372:Pediatrics / Q000458:organization & administration; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends; D011795:Surveys and Questionnaires; D014481:United States