Leah Tuzzio1, Evette J Ludman2, Eva Chang3, Lorella Palazzo4, Travis Abbott5, Edward H Wagner6, Robert J Reid7. 1. Research Associate at the Kaiser Permanente Washington Health Research Institute (formerly Group Health Research Institute) in Seattle, WA. tuzzio.l@ghc.org. 2. Senior Research Associate at the Kaiser Permanente Washington Health Research Institute (formerly Group Health Research Institute) in Seattle, WA. ludman.e@ghc.org. 3. Research Public Health Analyst at RTI International in Waltham, MA. echang@rti.org. 4. Research Associate at the Kaiser Permanente Washington Health Research Institute (formerly Group Health Research Institute) in Seattle, WA. palazzo.l@ghc.org. 5. Family Physician at Group Health Cooperative in Seattle, WA. abbott.a@ghc.org. 6. Director Emeritus of the MacColl Center for Health Care Innovation at the Kaiser Permanente Washington Health Research Institute (formerly Group Health Research Institute) in Seattle, WA. wagner.e@ghc.org. 7. Chief Scientist for Better Health at Trillium Health Partners Institute in Mississauga, Ontario, Canada. robert.reid@trilliumhealthpartners.ca.
Abstract
INTRODUCTION: Referral rates to specialty care from primary care physicians vary widely. To address this variability, we developed and pilot tested a peer-to-peer coaching program for primary care physicians. OBJECTIVES: To assess the feasibility and acceptability of the coaching program, which gave physicians access to their individual-level referral data, strategies, and a forum to discuss referral decisions. METHODS: The team designed the program using physician input and a synthesis of the literature on the determinants of referral. We conducted a single-arm observational pilot with eight physicians which made up four dyads, and conducted a qualitative evaluation. RESULTS: Primary reasons for making referrals were clinical uncertainty and patient request. Physicians perceived doctor-to-doctor dialogue enabled mutual learning and a pathway to return joy to the practice of primary care medicine. The program helped physicians become aware of their own referral data, reasons for making referrals, and new strategies to use in their practice. Time constraints caused by large workloads were cited as a barrier both to participating in the pilot and to practicing in ways that optimize referrals. Physicians reported that the program could be sustained and spread if time for mentoring conversations was provided and/or nonfinancial incentives or compensation was offered. CONCLUSION: This physician mentoring program aimed at reducing specialty referral rates is feasible and acceptable in primary care settings. Increasing the appropriateness of referrals has the potential to provide patient-centered care, reduce costs for the system, and improve physician satisfaction.
INTRODUCTION: Referral rates to specialty care from primary care physicians vary widely. To address this variability, we developed and pilot tested a peer-to-peer coaching program for primary care physicians. OBJECTIVES: To assess the feasibility and acceptability of the coaching program, which gave physicians access to their individual-level referral data, strategies, and a forum to discuss referral decisions. METHODS: The team designed the program using physician input and a synthesis of the literature on the determinants of referral. We conducted a single-arm observational pilot with eight physicians which made up four dyads, and conducted a qualitative evaluation. RESULTS: Primary reasons for making referrals were clinical uncertainty and patient request. Physicians perceived doctor-to-doctor dialogue enabled mutual learning and a pathway to return joy to the practice of primary care medicine. The program helped physicians become aware of their own referral data, reasons for making referrals, and new strategies to use in their practice. Time constraints caused by large workloads were cited as a barrier both to participating in the pilot and to practicing in ways that optimize referrals. Physicians reported that the program could be sustained and spread if time for mentoring conversations was provided and/or nonfinancial incentives or compensation was offered. CONCLUSION: This physician mentoring program aimed at reducing specialty referral rates is feasible and acceptable in primary care settings. Increasing the appropriateness of referrals has the potential to provide patient-centered care, reduce costs for the system, and improve physician satisfaction.
Authors: John W Beasley; Barbara Starfield; Chris van Weel; Walter W Rosser; Cynthia L Haq Journal: J Am Board Fam Med Date: 2007 Nov-Dec Impact factor: 2.657