Specialty Physician Designation in Referrals from a Vertically Integrated PCMH

Area of Science:

• Healthcare Management
• Medical Practice Patterns

Background:

• Historically, specialty physician referrals depended on specialist skill and prior relationships.
• Vertical integration within health systems has altered traditional referral dynamics.
• Current patterns of specialty physician designation in referrals are not well understood.

Purpose of the Study:

• To evaluate the proportion of referrals that designate a specific specialist physician.
• To examine factors influencing specialty physician designation in patient-centered medical home (PCMH) referrals.

Main Methods:

• A cross-sectional study analyzed 410 outpatient specialty referrals from a PCMH.
• Chart review assessed specialty physician designation, provider experience, referral reason, and time to visit.
• Univariate analysis, including Fisher exact tests, was employed.

Main Results:

• Only 11.2% of all specialty referrals specified a particular physician.
• Faculty physicians were more likely to name a specific specialist (21.4%) than residents (4.9%).
• No significant differences were found in referral reasons, destinations, or visit scheduling based on physician designation.

Conclusions:

• Patient-centered medical home referrals infrequently name a specific specialist.
• This suggests a declining reliance on individual specialist characteristics in the referral process.
• Referral patterns are evolving within integrated health systems.