Table 1.
Study | Inappropriate Referrals (%) | Condition(s) | Term Used to Define Inappropriate | Definition of Inappropriate |
---|---|---|---|---|
Lawler et al. 1990 | 19.2 | All conditions | Elective | Judgment of external expert (scale of 1 to 4, 4 being extremely unlikely to suffer harm without referral and could be managed by PCP). |
Donohoe et al. 1999 | 30 | All conditions | Inappropriate | Judgment of specialist physician (scale of 1 to 9 scale, 1 being “highly inappropriate”; 9 being “highly appropriate”). |
Albertson et al. 2000 | 17.4 | All conditions | Not indicated | Judgment of referring physician (e.g., comfortable treating, patient seeking additional reassurance not indicated). |
Harrington and Walsh 2001 | 41 | Rheumatology | Inappropriate | Judgment of specialist receiving referral (e.g., already receiving appropriate care, no autoimmune symptoms, prior complete evaluation, no prior evaluation by referring physician). |
Wallerstein and Seshadri 1994 | 0.7 | Pediatric developmental disability | Unnecessary | Judgment of specialist receiving referral (no evidence of chronic developmental disability and no need for further testing or services). |
Forrest et al. 2003 | 12.4 | All conditions | Discretionary | Four predefined criteria: common condition, high certainty, low urgency, cognitive assistance only. |
Forrest et al. 2006 | 17 | All conditions | Discretionary | Four predefined criteria: common condition, high certainty, low urgency, cognitive assistance only. |
Warren 1994 | 16 | Strabismus | Inappropriate, invalid, excessive | Change in management (excessive referrals when >30% of referrals for strabismus are not found to have strabismus). |
Reeder et al. 2004 | 42–65 | Pediatric musculoskeletal disorders | Inappropriate | Guidelines (2002 AAP Surgical Advisory Panel guidelines for referral to surgical subspecialties). |
Note: Limited to studies published in the United States.