Predictors of patient referrals by primary care residents to specialty care clinics

Background and Objectives: Physician referral patterns significantly impact costs, quality of care, and access to the health system. This paper examin es factors predictive of patient referrals to specialists by primary care r esidents. Methods: New adult patients (n=509) were randomly assigned to pri mary care residents at a university medical center. Patient referrals to sp ecialists were monitored for I year of care. Self-reported patient health s tatus, sociodemographic information, number of primary care visits, and phy sician practice style behaviors were incorporated into statistical analyses predicting specially referrals. Results: Patients who were referred to spe cialty care were significantly older, had poorer physical health, and saw t heir primary care physicians more often than patients who were not referred . Patients were most frequently referred to surgical specialty clinics. Aft er controlling for physical health status, gender and age, more frequent vi sits to a primary care resident physician who had a technically oriented st yle of care was associated with a greater total number of specialty clinic referrals. Conclusions: Patient variables, as well as physician practice st yle, have an important impact on the specialty referral process. Although t he appropriateness of referrals was not evaluated, these findings have impl ications for health care delivery.