SPECIALTY REFERRALS AMONG CALIFORNIA PHYSICIAN GROUPS

描述：本项目建议对决定因素进行前瞻性研究 三种常见慢性疾病之一的成人患者的转诊情况 病情--充血性心力衰竭(CHF)、良性前列腺增生症 (BPH)和消化性溃疡(PUD)。病人将从 加州十个医生团体的登记文件，这些团体拥有不同的 激励安排。其主要目标是研究 十所采用的财务安排和使用管理技术 关于将决定转介给专家的医生小组。三百 在十个医生小组工作的初级保健医生将参加 在书房里。将选择组以确保它们代表渐变 激励策略。该项目的次要目标是 评估转诊模式和质量之间的可能关联 关心。 研究人员将检查每个医生组，以确定 与保险公司的按人头计价安排的性质、医生报销 组内安排、组内组成(初级保健与 多专业)和非财务使用管理技术 这群人。他们还将对医生进行调查，以评估他们的人口统计 特点、专科培训、患者小组大小、知识和 对感兴趣的三个条件的安慰，对 这三个疾病领域的专家的可用性和质量 实践设置，以及对实践和转介指南的认识 作为与转诊有关的报销安排。这些患者中的 将确定患有三种目标疾病之一的医生，以及 每种疾病的2100名患者将被随机挑选。他们将会是 在基线和一年后进行调查。将收集的数据包括： 护理质量，包括全球和特定疾病功能的变化 状态；收到各种建议的流程措施；以及患者 满足感。 要解决的具体问题是：1)哪位患者、医生、 和实践特征会影响转诊到 针对管理型医疗环境中的每种情况的专家？这些因素是不是 在不同条件下变化？2)根据这些特征进行调整后， 管理保健医生报销安排的变化影响 推荐的可能性？3)创新，如推荐指南或 有组织的、即时的电话咨询会影响转介率 这些情况？4)转诊与更频繁地执行 适当的诊断和治疗干预，更好的功能 状态，还是更大的患者满意度？如果是的话，这些协会 独立于导致或预测转诊的因素？

Description: This project proposes to study prospectively the determinants of referral among adult patients with one of three common chronic conditions-- congestive heart failure (CHF), benign prostatic hyperplasia (BPH), and peptic ulcer disease (PUD). Patients will be selected from the enrollment files of ten California physician groups which have a variety of incentive arrangements. The principal objective is to study the effects of financial arrangements and utilization management techniques used by the ten physician groups on referral decisions to specialists. Three hundred primary care physicians working in the ten physician groups will participate in the study. Groups will be selected to ensure they represent a gradient of incentive strategies. A secondary objective of this project is to evaluate the possible association between referral patterns and quality of care. Study investigators will examine each physician group to determine the nature of its capitation arrangements with insurers, physician reimbursement arrangements within the group, group composition (primary care versus multispecialty), and nonfinancial utilization management techniques within the group. They will also survey physicians to assess their demographic characteristics, specialty training, patient panel size, knowledge of and comfort with the three conditions of interest, opinions about the availability and quality of specialists in the three disease areas in their practice setting, and awareness of practice and referral guidelines as well as reimbursement arrangements related to referrals. Patients of these physicians with one of the three target diseases will be identified, and 2,100 patients with each disease will be randomly selected. They will be surveyed at baseline and again at one year. Data to be collected include: quality of care, including change in global and disease-specific functional status; receipt of various recommended process measures; and patient satisfaction. The specific questions to be addressed are: 1) Which patient, physician, and practice characteristics affect the likelihood of referral to specialists for each condition in managed care settings? Do these factors vary across conditions? 2) After adjusting for these characteristics, does variation in managed care physician reimbursement arrangements affect the likelihood of referral? 3) Do innovations such as referral guidelines or structured, immediate telephone consultations affect referral rates for these conditions? 4) Are referrals related to more frequent performance of appropriate diagnostic and treatment interventions, better functional status, or greater patient satisfaction? If so, are the associations independent of the factors that lead to or predict referral?