SUBSPECIALIST REFERRALS IN AN ACADEMIC, PEDIATRIC SETTING - RATIONALE, RATES, AND COMPLIANCE

Appropriate referrals reduce healthcare costs and enhance patient sati sfaction. We evaluated the sub specialty referral pattern of a managed care general pediatric office over a 4-month period. Three-hundred-fo rty-six referrals (267 meeting inclusion criteria) to 24 subspecialtie s were generated during 4,219 office visits, with five subspecialties receiving 59% of the referrals. The main objective of each referral wa s management (100), diagnostic assistance (75), special procedure (63) , or a combination (29). Patients kept less than half of the referral appointments, with the highest (80%) and lowest (28%) compliance rates observed in cardiology and ophthalmology, respectively. Appointments made within four weeks of the referral were more likely to be kept tha n those with greater lag time (P = 0.001). The subspecialists prepared written, post-consultation responses to the referring physician in 73 % of cases, Presumptive and post-consultation diagnoses were congruent in 78% of those cases in which both diagnoses were noted. Overall, th e managed care format enabled our practice to track referral outcomes. The subspecialists' written responses also allowed for an educational exchange between physicians. Compliance with referral appointments is a substantial problem that needs to be addressed.