Referrals and the PCMH: how well do we know our neighborhood?

Area of Science:

• Internal Medicine
• Healthcare Management
• Health Services Research

Background:

• Patient-centered medical homes (PCMH) aim to improve care coordination.
• Referral patterns are crucial for efficient healthcare delivery and patient outcomes.
• Understanding factors influencing referrals is key to optimizing PCMH operations.

Purpose of the Study:

• To characterize referral patterns within an academic PCMH.
• To examine the association of provider experience and patient risk with referral decisions.

Main Methods:

• A descriptive analysis of referral data from an academic internal medicine PCMH (July-December 2014).
• Examined referrals for specialist visits, testing, and ancillary services for 12,000 patients.
• Utilized a generalized linear model and risk stratification tool to identify factors associated with referral placement.

Main Results:

• Residents placed more referrals per patient (1.9) than faculty (1.5).
• Residents referred highest-risk patients at a higher rate (0.327) compared to faculty (0.226).
• No significant difference in referrals for lower-risk patients between residents and faculty.

Conclusions:

• Provider experience and patient characteristics significantly influence referral patterns in academic PCMHs.
• Residents demonstrate a tendency to refer higher-risk patients more frequently than faculty.
• These findings highlight the need to consider provider-specific and patient-specific factors in referral management within PCMH settings.