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. 2022 Apr 19;37(13):3444–3452. doi: 10.1007/s11606-022-07574-6

Table 2.

Range of Factors Considered by Participants of Each Study When Making Referrals by Relational Domain

Factor considered when making referral decision
Specialist’s clinical expertise Interactions between patient and specialist Interactions between referring physician and specialist
Forrest et al. 2002 Technical capacity

Quality of prior feedback

Appointment availability

Patient request

Requirement of patient’s health plan

Proximity of specialist to patient’s home

Personal knowledge of the specialist
Kinchen et al. 2004

Medical skill

Board certification

Quality of communication

Medical school

Fellowship training institution

Previous experience with specialist

Patient convenience

Office location

Appointment timeliness

Likelihood of good patient-physician rapport

Insurance coverage

Patient preference for particular specialist

Specialist returns to primary physician

PCP relationship with specialist

Hospital affiliation

Attitudes of colleagues towards specialist

Specialist refers patients to primary physician

Abel et al. 2012

Reputation of specialist/facility

Specialist’s affiliation with cancer center

Availability of clinical trials at referral site

Patient’s preference for site of care

Distance of site from patient’s home

Patient’s ability to pay

Practice’s affiliation with specialist

Personal relationship with specialist

Possibility of losing patient to specialist

Barnett et al. 2012

My patients have good experiences with this physician

Physician has good patient rapport

Timely availability of appointments

Location convenient for patient

Patient request

Speaks patient’s language

Quality of communication with me

Shares my medical record system

Physician refers to me

Works in my hospital or practice

Brown et al. 2013

Report cards

Technical skill

Clinical judgement

Post-operative care

Risk-adjusted mortality

Outcomes other than mortality

Effective communication

Patient satisfaction Hospital affiliation
Gao et al. 2021

Patient complexity

Surgeon experience and volume

GIs would refer a family member to a trusted colorectal surgeon. Surgeons would refer a family member to a large or academic center.

Preference for care to be received locally

Specialist availability

Patient preference

GIs preferred to refer to colorectal surgeons while most general surgeons perform surgery on patients they diagnose

Preference to remain in health system

Makovkina and Kern 2021

Clinical judgement

Clinical reputation of physician’s organization

Geographic preference

Ease of scheduling

Patient feedback

Insurance coverage

Patient preference

Flexibility in accommodating urgent referrals

Preference or institutional pressure to refer within organization

Cost containment

Personal knowledge and trust of specialist

Ease of communication and coordination of care

Shared EMR