PROS Pearls:

* As part of the PROS Referral Process in Primary Care Study, investigators examined how physicians coordinate patient care for specialty referrals and the effects of these activities on the completion of referral care and referring physicians' satisfaction with the specialty care their patients receive.

* In this study, pediatricians scheduled appointments with specialists for 39 percent of the patients they referred and sent patient information to specialists for 51 percent of referrals.

* The odds of referral completion increased three-fold for those referrals for which the pediatrician scheduled the appointment and communicated with the specialist compared with those for which neither activity occurred.

* The satisfaction ratings of referring pediatricians increased significantly by any type of specialist feedback, especially feedback by both telephone and letter.

* Elements of specialists' letters that significantly increased physician ratings of quality included presence of patient history, suggestions for future care, followup arrangements, and plans for the specialist and referring physician to comanage the patient's care.

* Only the inclusion of plans for comanaging patient care was significantly related to the referring physicians' overall satisfaction.

* These results support the need for physicians who receive either primary care or subspecialty training to be educated on ways that patients can be successfully comanaged.