title: Ambulatory subspecialty visits in a large pediatric primary care network.
abstract: OBJECTIVE
  To determine patterns of subspecialty utilization within a pediatric primary care network.
  
  
  METHODS
  Paid claims from a large not-for-profit health plan for patients of The Pediatric Physicians' Organization at Children's, a network of private pediatric practices affiliated with Children's Hospital Boston.
  
  
  RESULTS
  The subspecialty visit rate was 1.01 visits per subject-year. In 2007, 56.8 percent of subjects had no subspecialty visits, whereas 4.2 percent had ≥ 5 visits; the corresponding figures in 2008 were 54.1 and 4.5 percent, respectively. The most frequently visited subspecialties were Ophthalmology, Orthopedics, Dermatology, Otorhinolaryngology, and Allergy/Immunology. Visit rates varied sevenfold by practice.
  
  
  CONCLUSIONS
  Wide practice variability in pediatric subspecialty utilization suggests an opportunity for reducing unnecessary visits. Better integration between primary care and the most commonly used subspecialties will be needed to meaningfully reduce unnecessary visits and enhance value.
authors.affiliation: The Pediatric Physicians' Organization at Children's, Brookline, MA 02445, USA. louis.vernacchio@childrens.harvard.edu
authors.forename: Louis
authors.initials: L
authors.lastname: Vernacchio
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Muto
authors.forename: Gregory
authors.initials: G
authors.lastname: Young
authors.forename: Wanessa
authors.initials: W
authors.lastname: Risko
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D006801:Humans; D008404:Massachusetts; D010372:Pediatrics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013038:Specialization