TY - JOUR
T1 - Specialty referral communication and completion in the community health center setting
AU - Zuckerman, Katharine E.
AU - Nelson, Kerrie
AU - Bryant, Tara K.
AU - Hobrecker, Karin
AU - Perrin, James M.
AU - Donelan, Karen
N1 - Funding Information:
This study was funded by a grant from the CRICO-Risk Management Foundation to Massachusetts General Hospital (PI = Zuckerman). Dr. Zuckerman’s effort was also supported by a National Research Service Award ( T32 HP10018 ) to the Harvard Pediatric Health Services Research Fellowship Program. The authors would like to thank all of the parents and health care providers for their participation. We additionally thank Esteban Barreto, Xin Cai, Gibran Minero, Michelle Connolly, Dianali Rivera, Tara Bryant, and Odeviz Soto for their assistance with data collection.
PY - 2011/7
Y1 - 2011/7
N2 - Objective: Parent and provider disagreement about children's care at the time of specialty referral may lead to incomplete referral, ie, not attending a specialty visit when referred. This study's objectives were first to assess parent-provider correlation in perspectives on referral necessity, seriousness of child's health problem, and parental understanding of referral among children referred to pediatric specialists, and second to assess whether these perspectives are associated with incomplete referral. Methods: Two months after specialty referral, parents and primary care providers completed a survey rating referral necessity, seriousness of problem, and parental understanding on a 4-part scale ("definitely yes" to "definitely no"). Parents were surveyed by telephone; providers completed one self-administered survey per referral. Using z tests and Pearson correlation coefficients, we summarized parent-provider agreement about referral necessity, seriousness of problem, and parent understanding. We applied logistic regression to test associations of parent and provider ratings for each variable with incomplete referral. Results: A total of 299 (60.0%) of 498 matched parent and provider surveys were included in the analysis. Parents had low correlation with providers in perspectives of referral necessity and seriousness of problem. Parents reported that referral was necessary more often than providers, and providers underestimated parents' self-reported understanding of the referral. Nearly 1 in 3 children had incomplete referral, and both parent and provider reports of lower necessity were associated with incomplete referral. Conclusions: Parents and providers hold divergent perspectives on referral necessity and seriousness of children's health problems; these perspectives may impact rates of incomplete referral. Improving communication around specialty referral might reduce incomplete referral.
AB - Objective: Parent and provider disagreement about children's care at the time of specialty referral may lead to incomplete referral, ie, not attending a specialty visit when referred. This study's objectives were first to assess parent-provider correlation in perspectives on referral necessity, seriousness of child's health problem, and parental understanding of referral among children referred to pediatric specialists, and second to assess whether these perspectives are associated with incomplete referral. Methods: Two months after specialty referral, parents and primary care providers completed a survey rating referral necessity, seriousness of problem, and parental understanding on a 4-part scale ("definitely yes" to "definitely no"). Parents were surveyed by telephone; providers completed one self-administered survey per referral. Using z tests and Pearson correlation coefficients, we summarized parent-provider agreement about referral necessity, seriousness of problem, and parent understanding. We applied logistic regression to test associations of parent and provider ratings for each variable with incomplete referral. Results: A total of 299 (60.0%) of 498 matched parent and provider surveys were included in the analysis. Parents had low correlation with providers in perspectives of referral necessity and seriousness of problem. Parents reported that referral was necessary more often than providers, and providers underestimated parents' self-reported understanding of the referral. Nearly 1 in 3 children had incomplete referral, and both parent and provider reports of lower necessity were associated with incomplete referral. Conclusions: Parents and providers hold divergent perspectives on referral necessity and seriousness of children's health problems; these perspectives may impact rates of incomplete referral. Improving communication around specialty referral might reduce incomplete referral.
KW - communication
KW - community health centers
KW - medical specialty
KW - pediatrics
KW - referral and consultation
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U2 - 10.1016/j.acap.2011.03.002
DO - 10.1016/j.acap.2011.03.002
M3 - Article
C2 - 21622041
AN - SCOPUS:79960525940
SN - 1876-2859
VL - 11
SP - 288
EP - 296
JO - Academic Pediatrics
JF - Academic Pediatrics
IS - 4
ER -