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PROS Referral Study |
The Referral
Study
There is an emerging recognition that primary care is central to the reorganization of the US health system. Policymakers have reached a widespread consensus that the US has more specialists than it needs. In response, payers are tightly restricting patients' and clinicians' use of specialty care through gatekeeping arrangements, utilization review, and referral guidelines. While extensive prior research on variation in physician utilization has shown important effects of differences in practice style, there is a growing awareness that little is known regarding the cost and quality implications of variation in referral patterns. This is an astounding gap in our knowledge base in primary care research, given that referrals are ubiquitous events and have important implications for the costs and quality of care.
Until recently, the decision to refer a patient to specialty care was primarily a personal one made by practitioners and patients. But doctors and patients no longer interact in isolation; health care has become a team sport, with referral decisions being made by a range of different players, including practitioners, patients, health plans, and employers.
This study is designed to address three broad research questions:
- How do pediatric practitioners refer patients?
- Which factors explain high and low referral rates?
- How do patients and practitioners evaluate the referral process three months after the decision to refer was made?
The specific objectives of this study are:
1. To characterize referral patterns by practitioners, selected diagnoses, and locus of the referral (i.e., those made during phone call versus those made during office visits) and determine how referrals are coordinated.
2. To understand why practitioners refer patients and to identify determinants of specific reasons for referral.
3. To estimate the potential influence on referral rates of practitioner characteristics--such as expertise and tolerance of uncertainty--and different payment mechanisms (i.e., gatekeeping versus non-gatekeeping health plans).
4. To assess outcomes of the referral process from the perspective of consumers and practitioners.
| Core support for the PROS network is provided by a grant from the Health Resources and Services Administration Maternal and Child Health Bureau |  |
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