Reasons for Choice of Referral Physician Among Primary Care and Specialist Physicians
Reasons for Choice of Referral Physician Among Primary Care and Specialist Physicians
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DOI：
10.1007/s11606-011-1861-z
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发表时间：
2012-05-01
影响因子：
5.7
通讯作者：
Landon, Bruce E.
中科院分区：
文献类型：
--
作者：
Barnett, Michael L.;Keating, Nancy L.;Landon, Bruce E.
专科转诊模式会影响医疗保健费用以及临床结果。对于特定的临床问题，转诊医生通常可以选择几位可以转诊的医生。一旦做出转诊决定，个人医生的选择可能会产生重要的下游影响。旨在检查初级保健和专科医师选择某些特定同事进行转诊的原因以及这些原因在不同专业之间有何不同。基于网络的横断面调查，辅以行政索赔数据分析。共有 616 名办公室患者护理专业医生，他们是学术医生组织的成员，并于 2006 年治疗了 Medicare 患者。总共 386 名受访者（63% 回应）率）收到了一份其他医生姓名的“名册”，我们根据共享医疗保险患者预测他们与这些医生有关系。在其“专业网络”（由受访者承认与其有专业关系的任何列出的医生组成）中的医生中，受访者报告了他们是否推荐过这些医生，如果是，则提供了最多两个他们推荐该特定同事的原因。使用逻辑回归，我们检查了不同专家认可转诊所选同事的具体原因的可能性。初级保健医生 (PCP) 向其“专业网络”同事中的 66% 发起转诊，而内科和外科专家分别向 49% 和 52% 的同事发起转诊（与 PCP 相比，p < 0.001）。调整后，内科专家比 PCP 更不可能以与同事沟通方便为由（RR = 0.69，95% CI = 0.49-0.91），而内科和外科专家比 PCP 更不可能将“共享我的病历系统”作为转诊理由（内科专家 RR = 0.13，95% CI 0.03-0.40，外科专家 RR = 0.26， 95% CI = 0.05-0.78）。专家经常绕过 PCP 发起转诊。在选择具体的医生进行参考时，PCP 通常更关心医生之间的沟通和患者的访问。修改医生之间的转诊做法可能需要考虑到这种行为模式。
Specialty referral patterns can affect health care costs as well as clinical outcomes. For a given clinical problem, referring physicians usually have a choice of several physicians to whom they can refer. Once the decision to refer is made, the choice of individual physician may have important downstream effects.To examine the reasons why primary care and specialist physicians choose certain specific colleagues to refer to and how those reasons differ by specialty.Cross-sectional Web-based survey supplemented with analysis of administrative claims data.A total of 616 physicians in office-based patient care specialties who were members of an academic physicians' organization and treated Medicare patients in 2006.A total of 386 respondents (63% response rate) were presented with a "roster" of other physicians' names with whom we predicted they had a relationship based on sharing Medicare patients. Among physicians in their "professional network" (consisting of any listed physician with whom respondents acknowledged a professional relationship), respondents reported if they referred to those physicians, and if so, provided up to two reasons why they referred to that particular colleague. Using logistic regression, we examined the likelihood that different specialists would endorse specific reasons for referring to chosen colleagues.Primary care physicians (PCPs) initiated referrals to 66% of their "professional network" colleagues, while medical and surgical specialists initiated referrals to 49% and 52%, respectively (p < 0.001 for both versus PCPs). After adjustment, medical specialists were less likely than PCPs to cite ease of communication with colleagues (RR = 0.69, 95% CI = 0.49-0.91), and medical and surgical specialists were less likely than PCPs to cite "shares my medical record system" as a reason to refer (medical specialist RR = 0.13, 95% CI 0.03-0.40, surgical specialist RR = 0.26, 95% CI = 0.05-0.78).Specialists frequently initiate referrals, bypassing PCPs. In choosing specific physicians to refer to, PCPs are more often concerned with between-physician communication and patient access. Modifying referral practices among doctors may need to account for such patterns of behavior.