Williams et al 4, 5 proposed 3 coordination events involved in the referral process: (1) the referring physician communicates reasons for the referral and relevant patient information to the specialist, (2) the specialist completes the referral by communicating findings to the referring physician, and (3) the referring physician, specialist, and patient negotiate continuing care arrangements. The success of primary care physicians' coordination efforts depends on tasks that they and other providers perform. Integrating referral care with primary care is a complex and time-consuming process. 1, 2 Breakdowns in coordination hold the potential for missed or delayed diagnoses and treatments, repeated or unnecessary testing, increased iatrogenic morbidity, adverse drug reactions, and increased risk of litigation. Optimal coordination involves the documentation of patient care activities, interprovider communication, and the integration of service delivery into a single medical home. WHEN SPECIALTY referrals are made, primary care physicians must coordinate service delivery across settings, multiple providers, and time to maintain a seamless continuum of care. Improvements in the referral process may be achieved through better communication and collaboration between primary care physicians and specialists. Elements of specialists' letters that significantly increased physician ratings of letter quality included presence of patient history, suggestions for future care, follow-up arrangements, and plans for comanaging care only the inclusion of plans for comanaging patient care was significantly related to the referring physicians' overall satisfaction.Ĭonclusions Better coordination between referring physicians and specialists increases physician satisfaction with specialty care and enhances referral completion. Referring physicians' satisfaction ratings were significantly increased by any type of specialist feedback and were highest for referrals involving specialist feedback by both telephone and letter. The adjusted odds of referral completion were increased 3-fold for those referrals for which the pediatrician scheduled the appointment and communicated with the specialist compared with those for which neither activity occurred. Results Pediatricians scheduled appointments with specialists for 39.3% and sent patient information to specialists for 50.8% of referrals. Referral completion was defined as receipt of written communication of referral results from the specialist. Data sources included a physician survey completed when the referral was made (response rate, 99%) and a physician survey and medical record review conducted 3 months later (response rate, 85%). Objectives To describe how physicians coordinate patient care for specialty referrals and to examine the effects of these activities on referring physicians' satisfaction with the specialty care their patients receive and referral completion.ĭesign and Methods Prospective study of a consecutive sample of referrals (N=963) made from the offices of 122 pediatricians in 85 practices in a national practice-based research network.
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