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Christopher B. Forrest, MD, PhD; Gordon B. Glade, MD; Alison E. Baker, MS; Alison Bocian, MS; Sarah von Schrader, MA; Barbara Starfield, MD, MPH

Arch Pediatr Adolesc Med. 2000;154:499-506.

Objectives  To describe how physicians coordinate patient care for specialty referrals and to examine the effects of these activities on referring physicians' satisfaction with the specialty care their patients receive and referral completion.

Design and Methods  Prospective study of a consecutive sample of referrals (N=963) made from the offices of 122 pediatricians in 85 practices in a national practice-based research network. Data sources included a physician survey completed when the referral was made (response rate, 99%) and a physician survey and medical record review conducted 3 months later (response rate, 85%). Referral completion was defined as receipt of written communication of referral results from the specialist.

Results  Pediatricians scheduled appointments with specialists for 39.3% and sent patient information to specialists for 50.8% of referrals. The adjusted odds of referral completion were increased 3-fold for those referrals for which the pediatrician scheduled the appointment and communicated with the specialist compared with those for which neither activity occurred. Referring physicians' satisfaction ratings were significantly increased by any type of specialist feedback and were highest for referrals involving specialist feedback by both telephone and letter. Elements of specialists' letters that significantly increased physician ratings of letter quality included presence of patient history, suggestions for future care, follow-up arrangements, and plans for comanaging care; only the inclusion of plans for comanaging patient care was significantly related to the referring physicians' overall satisfaction.

Conclusions  Better coordination between referring physicians and specialists increases physician satisfaction with specialty care and enhances referral completion. Improvements in the referral process may be achieved through better communication and collaboration between primary care physicians and specialists.

From the Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Md (Drs Forrest and Starfield and Ms von Schrader); Pediatric Research in Office Settings, Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, Ill (Dr Glade, Ms Baker, and Ms Bocian); Department of Pediatrics, University of Utah School of Medicine, Salt Lake City (Dr Glade).

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