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Variability in consultation rates and practitioner level of diagnostic certainty
N S Calman1, R B Hyman, W Licht
1Institute for Urban Family Health, Inc., New York, New York 10003.
The Journal of Family Practice
|July 1, 1992
Summary
Family physician and nurse practitioner consultation rates vary significantly. Higher diagnostic certainty correlates with increased specialty referrals, suggesting a link between practitioner knowledge and consultation frequency.
Area of Science:
- Primary Care
- Medical Practice Management
- Health Services Research
Background:
- Investigated variability in consultation practices among family physicians and family nurse practitioners in an urban group practice.
- Examined relationships between referring practitioner diagnostic certainty, request specificity, and consultation frequency.
Purpose of the Study:
- To determine variability in consultation practices among primary care providers.
- To analyze the influence of diagnostic certainty and request specificity on specialty consultation rates.
Main Methods:
- Analyzed 35,218 family practice visits over 19 months involving six family physicians and two family nurse practitioners.
- Consultation requests were directed to nine medical and surgical specialties.
- Requests were scored based on referring practitioner's diagnostic certainty and request specificity.
Main Results:
- Observed nearly a fivefold variation in overall specialty consultation rates among providers.
- Referral rate showed a positive correlation with diagnostic certainty (r = .40).
- No consistent relationship was found between request specificity and referral rate.
Conclusions:
- Significant variability in consultation rates exists even within the same practice among primary care providers.
- Increased diagnostic certainty is associated with higher rates of specialty consultation.
- Diagnostic certainty may indicate practitioner knowledge, suggesting reevaluation of financial incentives impacting specialty consultations.