Provider Experience, Chronic Disease Impact PCMH Referral Rates

Patients with common chronic diseases, as well as those seen by less experienced providers, are more likely to receive specialty referrals than others being treated within the patient-centered medical home environment, according to an article published in the American Journal of Managed Care.

While faculty clinicians at the Medical University of South Carolina’s (MUSC) academic internal medicine PCMH placed an average of 0.271 referrals per visit, residents operating under faculty supervision were nearly twice as likely to direct a patient to a specialist, delivering an average of 0.423 referrals per visit. 

Residents were also more likely to hand out more referrals per patient, and tended to request referrals for patients who were lower-income or more reliant on Medicare or Medicaid than those patients seen by faculty members.

Patients with higher chronic disease management needs, including those with COPD, peripheral vascular disease, depression, obesity, and substance abuse problems, received more referrals in general than their healthier counterparts.

Even though the patient-centered medical homeencourages a team-based approach to comprehensive patient care, and actively invites specialty providers to collaborate with the primary care environment, referrals can produce confusion, duplication, patient data siloes, and extra expenses that may negatively impact care coordination.