FOR RELEASE December 30, 1996
Contact: AHCPR Public Affairs
(301) 594-1364
Howard Holland ext. 1374
Salina Prasad ext. 1317
AHCPR EXAMINING PATIENT REFERRAL PATTERNS
The federal Agency for Health Care Policy and Research (AHCPR) today announced the funding of 13 new research projects: eight projects to determine how the referral of primary care patients to medical specialists and other specialized services affects the quality and cost of health care; and five projects to improve primary care services overall.
More than half of all Americans are now covered by managed care plans, which often require the use of a primary care physician or gatekeeper to manage the referral of patients from primary to specialty care. To strengthen the scientific base underpinning the referral policies of health plans, AHCPR issued a call in early 1996 for research applications on the referral of patients to specialists.
The following eight studies, with a total estimated funding of $4.79 million, were chosen from among the applicants. They are:
o Nephrologist Care and Outcomes in Renal Insufficiency.
(Grant No.: HS09398) Principal investigator: Jerome L.
Avorn, M .D., Brigham and Women's Hospital, Boston, Mass.
1 996-1998. Total estimated funding: $634,179.
Determines the appropriate timing of patient referrals
to a nephrologist prior to the diagnosis of end-stage
renal disease (ERSD); examines how use of a
nephrologist affects the clinical course of ESRD and
outcomes; and also investigates other issues.
o Specialty Care in Closed Versus Open Access HMOs.
(Grant No.: HS09414) Principal investigator: Jose
Escarce, M.D., University of Pennsylvania,
Philadelphia, Pa. 1996-1998. Total estimated
funding: $707,328.
Examines the use of primary care and specialist
services by patients in a closed-panel gatekeeper HMO
plan versus those in a point-of-service (POS) plan.
Also examines whether primary care physicians refer
patients in the two plans at different rates and the
factors influencing the choice of specialists.
o Referrals in Primary Care. (Grant No.: HS09397)
Principal investigator: Peter Franks, MBBS, MS,
Highland Hospital, Rochester, N.Y. 1996-1998. Total
estimated funding: $469,112.
Examines variations in referral rates among primary
care physicians in a large managed care organization,
characteristics of the patients, physicians, and
practices associated with these variations, and the
impact of referral rate variations on costs and patient
outcomes.
o Unmet Need and Use of Vision Care by Medicare
Beneficiaries. (Grant No.: HS09424) Principal
investigator: Carol Mangione, M.D., University of
California, Los Angeles, School of Medicine, Los
Angeles, Calif. 1996-1998. Total estimated
funding: $694,285.
Investigates how the use of specialist referrals and
services may be affected by payment organization.
Focuses on the use of vision care services for Medicare
patients in fee-for-service versus capitated managed
care settings.
o Patterns of Referral and Care for Children on Medicaid.
(Grant No.: HS09416) Principal Investigator: James
Perrin, M.D., Massachusetts General Hospital, Boston,
Mass. 1996-1998. Total estimated funding: $245,892.
Focuses on the consequences of the referral of children
enrolled in Medicaid to pediatric specialists, compared
with adult specialists, for common and uncommon
pediatric chronic conditions.
o Specialty Referrals Among California Physician Groups.
(Grant No.: HS09372) Principal investigator: Joseph
Selby, M.D., Kaiser Foundation Research Institute,
Oakland, Calif. 1996-1998. Total estimated
funding: $725,925.
Examines the determinants of referral among 6,300 adult
California managed care patients with one of three
common chronic conditions; the possible effect of
plans' financial arrangements and utilization
management techniques on referral decisions; and the
possible association between referral patterns and
quality of care.
o Managed Care and the Primary-Specialty Care Interface.
(Grant No.: HS09377) Principal investigator: Barbara
Starfield, M.D., M.P.H., Ambulatory Sentinel Practice
Network, Denver, Colo. 1996-1998. Total estimated
funding: $909,794.
Characterizes referral patterns by primary care
physicians and determines how those patterns and the
coordination of referrals are influenced by financial
incentives and organization controls imposed by managed
care organizations.
o Analysis of Physician Referrals of Medicare Patients.
(Grant No.: HS09439) Principal investigator: Bruce C.
Stuart, Ph.D., Pennsylvania State University,
University Park, Pa. 1996-1998. Total estimated
funding: $403,397.
Characterizes patterns of physician referrals and
consultations in the treatment of noninstitutionalized
elderly and disabled Medicare beneficiaries, and
identifies differences in cost and patient outcomes
associated with specialist referrals for treatment of
cardiovascular disease in Medicare patients.
AHCPR also announced today the funding of five additional studies, with a total estimated funding of $3.54 million, to improve primary care. They are:
o Prevention and Competing Demands in Primary Care
Practice. (Grant No.: HS08776) Principal
investigator: Benjamin F. Crabtree, Ph.D., University
of Nebraska Medical Center, Omaha, Neb. 1996-1999.
Total estimated funding: $879,978.
Investigates why primary care physicians do or do not
provide preventive health services as part of their
practice, and the competing demands on physicians for
the delivery of medical and clinical preventive
services.
o Effective Organization of Adolescent Health Services.
(Grant No.: HS08192) Principal investigator: Jonathan
B. Klein, M.D., University of Rochester School of
Medicine, Rochester, N.Y. 1996-1998. Total estimated
funding: $311,642.
Analyzes how the organization of adolescent health
services affects teenagers' access to care.
o State Service-Contingent Programs for Health Providers.
(Grant No.: HS09165) Principal investigator: Donald E.
Pathman, University of North Carolina, Chapel Hill,
N.C. 1996-1999. Total estimated funding: $546,766.
Evaluates the effectiveness of state service-contingent
programs and the various methods they use to reduce
primary care provider shortage and maldistribution.
o Health Education in an HMO: Effectiveness and
Efficiency. (Grant No.: HS08641) Principal
investigator: Ronald W. Toseland, Ph.D., State
University of New York, Albany, N.Y. 1996-2000. Total
estimated funding: $1.22 million.
Compares the short- and long-term effects of a managed
care program to teach health education, coping, and
other skills to individuals who care for their frail
elderly spouses, and examines the impact of the
training on caregivers' and care recipients' health
care utilization and costs.
o Couples' Preference for Prostate Cancer Screening.
(Grant No.: HS08992) Principal investigator: Robert J.
Volk, Ph.D., University of Texas Medical Branch,
Galveston, Texas. 1996-1998. Total estimated
funding: $586,610.
Determines the appropriateness of prostate cancer
screening from the perspective of men who have the
disease, and of their spouses. The researchers will
also examine differences in preferences among non-Hispanic
white, Mexican-American, and African-American husbands and
wives.
The Agency for Health Care Policy and Research, a part of the Department of Health and Human Services, is the lead agency charged with supporting research designed to improve the quality of health care, reduce its cost, and enhance access to essential services. AHCPR's broad programs of research and technology assessment bring practical, science-based information to medical practitioners, and to consumers and other health care purchasers. To find out more about AHCPR, its research findings and publications, visit AHCPR's home page on the World Wide Web, at http://www.ahcpr.gov/
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