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Variability in physician referral decisions.

Barbara Starfield¹, Christopher B Forrest, Paul A Nutting

¹School of Public Health, Johns Hopkins University, Baltimore, USA.

The Journal of the American Board of Family Practice

|December 5, 2002

Summary

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Primary care physicians show unexplained variability in specialist referrals for common conditions. This inconsistency in referral patterns may significantly impact healthcare costs and patient outcomes, warranting further investigation.

Area of Science:

Health Services Research
General Practice
Medical Decision Making

Background:

Referral patterns of primary care physicians may contribute to variability in healthcare interventions and outcomes.
Understanding physician decision-making in referrals is crucial for optimizing patient care pathways.

Purpose of the Study:

To examine primary care physician decision-making processes regarding referrals for common adult and childhood conditions.
To identify factors influencing the choice of specialists for patient referrals.

Main Methods:

136 family physicians from 80 practices recorded referral reasons and specialist expectations for common conditions.
Data collected on referrals with at least seven instances to specific specialists.

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Main Results:

Most referrals were short-term (<12 months) and for consultation (over 50%).
No clear differences in referral reasons or expectations explained the choice between different specialist types.
Shared care expectations were higher for referrals to non-physicians compared to physicians.

Conclusions:

Significant unexplained variability exists in specialist referral patterns among family physicians for specific conditions.
The reasons for referring patients with the same condition to different specialist types (e.g., surgical vs. medical) remain unclear.
The potential impact of this referral variability on healthcare costs and patient outcomes requires further intensive study.