Coordination of specialty referrals and physician satisfaction with referral care

Objectives: To describe how physicians coordinate patient care for specialt y referrals and to examine the effects of these activities on referring phy sicians' satisfaction with the specialty care their patients receive and re ferral 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 n ational practice-based research network. Data sources included a physician survey completed when the referral was made (response rate, 99%) and a phys ician survey and medical record review conducted 3 months later (response r ate, 85%). Referral completion was defined as receipt of written communicat ion of referral results from the specialist. Results: Pediatricians scheduled appointments with specialists for 39.3% an d sent patient information to specialists for 50.8% of referrals. The adjus ted odds of referral completion were increased 3-fold for those referrals f or which the pediatrician scheduled the appointment and communicated with t he specialist compared with those for which neither activity occurred. Refe rring physicians' satisfaction ratings were significantly increased by any type of specialist feedback and were highest for referrals involving specia list feedback by both telephone and letter. Elements of Specialists' letter s that significantly increased physician ratings of letter quality included presence of patient history, suggestions for future care, follow-up arrang ements, and plans for comanaging care; only the inclusion of plans for coma naging patient care was significantly related to the referring physicians' overall satisfaction. Conclusions: Better coordination between referring physicians and specialis ts increases physician satisfaction with specialty care and enhances referr al completion. Improvements in the referral process may be achieved through better communication and collaboration between primary care physicians and specialists.