papers

Effects of comorbidity and clustering upon referrals in primary care

J Am Board Fam Pract 18:449-452.

Department of Family Medicine, University of Washington, Seattle, WA, USA

OBJECTIVE: To examine the effect of patient characteristics and comorbidity on referrals in primary care.

METHODS: Cross-sectional analysis of patient encounters and referrals during a 1-year period for a primary care network of 9 clinics. The analysis adjusted for the clustering effect of physicians and clinics on the data.

RESULTS: 23,720 specialty referrals were generated from 251,240 patient encounters, resulting in a total referral rate of 9.4 referrals per 100 encounters. Age, gender, and certain comorbid conditions were significant predictors of referral for any given encounter.

CONCLUSIONS: Patient characteristics and comorbidity are predictors of referral. Studies of primary care processes need to account for clustering of physicians and clinics in their research design.

PMID: 16322407