Skip Navigation Archive: U.S. Department of Health and Human Services
Archive: Agency for Healthcare Research Quality
Archive print banner

AHCPR Examining Patient Referral Patterns

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to for current information.

Press Release Date: December 30, 1996

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:

  • Nephrologist Care and Outcomes in Renal Insufficiency. (Grant No.: HS09398) Principal investigator: Jerome L. Avorn, M.D., Brigham and Women's Hospital, Boston, MA. 1996-1998. 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.

  • Specialty Care in Closed Versus Open Access HMOs. (Grant No.: HS09414) Principal investigator: José 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.

  • Referrals in Primary Care. (Grant No.: HS09397) Principal investigator: Peter Franks, M.B.B.S., M.S., Highland Hospital, Rochester, NY. 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.

  • Unmet Needs and Use of Vision Care by Medicare Beneficiaries. (Grant No.: HS09424) Principal investigator: Carol Mangione, M.D., University of California, Los Angeles, CA. 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.

  • Patterns of Referral and Care for Children on Medicaid. (Grant No.: HS09416) Principal Investigator: James Perrin, M.D., Massachusetts General Hospital, Boston, MA. 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.

  • Specialty Referrals Among California Physician Groups. (Grant No.: HS09372) Principal investigator: Joseph Selby, M.D., Kaiser Foundation Research Institute, Oakland, CA. 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.

  • Managed Care and the Primary-Specialty Care Interface. (Grant No.: HS09377) Principal investigator: Barbara Starfield, M.D., Ambulatory Sentinel Practice Network, Denver, CO. 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.

  • 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:

  • Prevention and Competing Demands in Primary Care Practice. (Grant No.: HS08776) Principal investigator: Benjamin F. Crabtree, Ph.D., University of Nebraska Medical Center, Omaha, NE. 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.

  • Effective Organization of Adolescent Health Services. (Grant No.: HS08192) Principal investigator: Jonathan B. Klein, M.D., University of Rochester School of Medicine, Rochester, NY. 1996-1998. Total estimated funding: $311,642.

    Analyzes how the organization of adolescent health services affects teenagers' access to care.

  • State Service-Contingent Programs for Health Providers. (Grant No.: HS09165) Principal investigator: Donald E. Pathman, University of North Carolina, Chapel Hill, NC. 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.

  • Health Education in an HMO: Effectiveness and Efficiency. (Grant No.: HS08641) Principal investigator: Ronald W. Toseland, Ph.D., State University of New York, Albany, NY. 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.

  • Couples' Preference for Prostate Cancer Screening. (Grant No.: HS08992) Principal investigator: Robert J. Volk, Ph.D., University of Texas Medical Branch, Galveston, TX. 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.

For additional information, contact AHCPR Public Affairs: Howard Holland, (301) 427-1857; Salina Prasad, (301) 427-1864.

The information on this page is archived and provided for reference purposes only.


AHRQ Advancing Excellence in Health Care