title: Design and Implementation of a Physician Coaching Pilot to Promote Value-Based Referrals to Specialty Care.
abstract: Referral rates to specialty care from primary care physicians vary widely. To address this variability, we developed and pilot tested a peer-to-peer coaching program for primary care physicians.
  
  
  
  To assess the feasibility and acceptability of the coaching program, which gave physicians access to their individual-level referral data, strategies, and a forum to discuss referral decisions.
  
  
  
  The team designed the program using physician input and a synthesis of the literature on the determinants of referral. We conducted a single-arm observational pilot with eight physicians which made up four dyads, and conducted a qualitative evaluation.
  
  
  
  Primary reasons for making referrals were clinical uncertainty and patient request. Physicians perceived doctor-to-doctor dialogue enabled mutual learning and a pathway to return joy to the practice of primary care medicine. The program helped physicians become aware of their own referral data, reasons for making referrals, and new strategies to use in their practice. Time constraints caused by large workloads were cited as a barrier both to participating in the pilot and to practicing in ways that optimize referrals. Physicians reported that the program could be sustained and spread if time for mentoring conversations was provided and/or nonfinancial incentives or compensation was offered.
  
  
  
  This physician mentoring program aimed at reducing specialty referral rates is feasible and acceptable in primary care settings. Increasing the appropriateness of referrals has the potential to provide patient-centered care, reduce costs for the system, and improve physician satisfaction.
authors.affiliation: Research Associate at the Kaiser Permanente Washington Health Research Institute (formerly Group Health Research Institute) in Seattle, WA. tuzzio.l@ghc.org.
authors.forename: Leah
authors.initials: L
authors.lastname: Tuzzio
authors.affiliation: Senior Research Associate at the Kaiser Permanente Washington Health Research Institute (formerly Group Health Research Institute) in Seattle, WA. ludman.e@ghc.org.
authors.forename: Evette J
authors.initials: EJ
authors.lastname: Ludman
authors.affiliation: Research Public Health Analyst at RTI International in Waltham, MA. echang@rti.org.
authors.forename: Eva
authors.initials: E
authors.lastname: Chang
authors.affiliation: Research Associate at the Kaiser Permanente Washington Health Research Institute (formerly Group Health Research Institute) in Seattle, WA. palazzo.l@ghc.org.
authors.forename: Lorella
authors.initials: L
authors.lastname: Palazzo
authors.affiliation: Family Physician at Group Health Cooperative in Seattle, WA. abbott.a@ghc.org.
authors.forename: Travis
authors.initials: T
authors.lastname: Abbott
authors.affiliation: Director Emeritus of the MacColl Center for Health Care Innovation at the Kaiser Permanente Washington Health Research Institute (formerly Group Health Research Institute) in Seattle, WA. wagner.e@ghc.org.
authors.forename: Edward H
authors.initials: EH
authors.lastname: Wagner
authors.affiliation: Chief Scientist for Better Health at Trillium Health Partners Institute in Mississauga, Ontario, Canada. robert.reid@trilliumhealthpartners.ca.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Reid
mesh_terms: D001291:Attitude of Health Personnel; D003362:Cost-Benefit Analysis; D006801:Humans; D007400:Interprofessional Relations; D007588:Job Satisfaction; D007858:Learning; D000071252:Mentoring; D018802:Patient-Centered Care; D058007:Physicians, Primary Care; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D015397:Program Evaluation; D012017:Referral and Consultation; D013038:Specialization