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Research ArticleOriginal Research

Referral Rates Vary Widely Between Family Medicine Practices

Hamza El Ayadi, Alpa Desai, Ross E. Jones, Elvira Mercado, Maribeth Williams, Benjamin Rooks and Peter J. Carek
The Journal of the American Board of Family Medicine November 2021, 34 (6) 1183-1188; DOI: https://doi.org/10.3122/jabfm.2021.06.210213
Hamza El Ayadi
From Department of Community Health and Family Medicine, University of Florida (HEA, AD, EM, MW, BR, PJC); Department of Community Health and Family Medicine, University of Florida - Jacksonville (REJ).
BS
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Alpa Desai
From Department of Community Health and Family Medicine, University of Florida (HEA, AD, EM, MW, BR, PJC); Department of Community Health and Family Medicine, University of Florida - Jacksonville (REJ).
DO
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Ross E. Jones
From Department of Community Health and Family Medicine, University of Florida (HEA, AD, EM, MW, BR, PJC); Department of Community Health and Family Medicine, University of Florida - Jacksonville (REJ).
MD
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Elvira Mercado
From Department of Community Health and Family Medicine, University of Florida (HEA, AD, EM, MW, BR, PJC); Department of Community Health and Family Medicine, University of Florida - Jacksonville (REJ).
MD
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Maribeth Williams
From Department of Community Health and Family Medicine, University of Florida (HEA, AD, EM, MW, BR, PJC); Department of Community Health and Family Medicine, University of Florida - Jacksonville (REJ).
MD, MSCR
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Benjamin Rooks
From Department of Community Health and Family Medicine, University of Florida (HEA, AD, EM, MW, BR, PJC); Department of Community Health and Family Medicine, University of Florida - Jacksonville (REJ).
MS
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Peter J. Carek
From Department of Community Health and Family Medicine, University of Florida (HEA, AD, EM, MW, BR, PJC); Department of Community Health and Family Medicine, University of Florida - Jacksonville (REJ).
MD, MS
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  • Article
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Article Figures & Data

Tables

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    Table 1.

    Average Monthly Demographic Characteristics of the Referred Patients by Clinic Group

    P
    OverallHighMediumLowHigh v MediumMedium v LowHigh v Low
    Monthly referrals19836214683
    Monthly visits9731304723855
    Monthly referral rate20.3%27.8%20.2%9.9%<0.001<0.001<0.001
    Avg encounter length (minutes)64.9 (23.1)69.3 (22.9)64.0 (25.6)61.0 (19.6)0.9270.9670.881
    Age of patients
        18 to 4465 (32.7%)120 (33.2%)48 (33.2%)26 (31.6%)0.9990.9250.422
        45 to 6491 (45.7%)165 (45.5%)65 (44.4%)39 (47.5%)0.9060.8240.641
        65+43 (21.6%)77 (21.3%)33 (22.4%)17 (20.9%)0.8330.8360.645
    Gender
        Female124 (62.8%)231 (63.9%)95 (65.0%)49 (59.4%)0.8690.444<0.001
        Male74 (37.2%)131 (36.1%)51 (35.0%)34 (40.6%)
    Race/ethnicity
        Non-Hispanic White117 (59.3%)156 (43.0%)84 (57.2%)66 (79.2%)0.0040.001<0.001
        Non-Hispanic Black58 (29.5%)171 (47.3%)37 (25.2%)12 (14.1%)<0.0010.078<0.001
        Hispanic12 (6.0%)21 (5.8%)14 (9.3%)2 (2.9%)0.1830.0750.247
        Other11 (5.3%)14 (3.9%)12 (8.3%)3 (3.8%)0.0730.2820.999
    Marital status
        Committed relationship86 (43.6%)125 (34.6%)65 (44.3%)44 (53.3%)0.0290.2720.022
        No committed relationship112 (56.4%)240 (66.4%)81 (55.7%)39 (46.7%)
    Payer type
        Medicaid47 (23.8%)118 (32.6%)35 (23.6%)12 (14.3%)0.0700.123<0.001
        Medicare56 (28.4%)110 (30.5%)38 (25.9%)24 (28.7%)0.3840.7500.481
        Charity2 (0.9%)9 (2.6%)<1 (<0.1%)<1 (<0.1%)0.3320.9990.674
        Self-pay8 (3.9%)12 (3.4%)6 (3.8%)4 (4.4%)0.8620.9990.873
    • View popup
    Table 2.

    Average Monthly Demographic Characteristics of the Total Patient Population of Clinics by Clinic Group

    Group
    OverallP*HighP*MediumP*LowP*
    Monthly visits9731304723855
    Age
        18 to 44414 (42.5%)0.014565 (43.3%)0.001340 (47.0%)0.002318 (37.2%)0.347
        45 to 64338 (34.8%)0.004455 (34.9%)<0.001241 (33.3%)0.013307 (35.9%)0.060
        65+221 (22.7%)0.832284 (21.8%)0.892142 (19.7%)0.483230 (26.9%)0.256
    Gender
        Female595 (61.2%)0.758825 (63.3%)0.898447 (61.8%)0.520494 (57.8%)0.916
        Male378 (38.8%)479 (36.7%)276 (38.2%)361 (42.2%)
    Race/ethnicity
        Non-Hispanic White607 (62.4%)0.430549 (42.1%)0.781463 (64.0%)0.164741 (86.7%)0.104
        Non-Hispanic Black254 (26.1%)0.403616 (47.2%)0.999135 (18.7%)0.08363 (7.4%)0.039
        Hispanic45 (4.6%)0.49960 (4.6%)0.42350 (6.9%)0.34018 (2.1%)0.999
        Other67 (6.9%)0.59878 (6.0%)0.15375 (10.4%)0.52234 (4.0%)0.999
    Marital status
        Committed relationship429 (44.1%)0.928425 (32.6%)0.738349 (48.3%)0.461464 (54.3%)0.917
        No committed relationship544 (55.9%)879 (67.4%)374 (51.7%)391 (45.7%)
    Payer type
        Medicaid165 (17.0%)0.031405 (31.1%)0.62166 (9.1%)<0.00163 (7.4%)0.039
        Medicare295 (30.3%)0.628396 (30.4%)0.999167 (23.1%)0.513328 (38.4%)0.115
        Charity16 (1.6%)0.73122 (1.7%)0.43813 (1.8%)0.53911 (1.3%)0.999
        Self-pay68 (7.0%)0.169152 (11.7%)<0.00129 (4.0%)0.9937 (4.3%)0.999
    • ↵* P values represent comparisons between the proportion of patients referred versus the proportion of patients in the general clinic population.

    • View popup
    Table 3.

    Adjusted Rate Ratios for the Change in Monthly Referral Rates over Time

    All Clinics*PBy Clinic Group*†P
    Monthly referral rate ratio1.002 (1.001, 1.003)<0.0011.000 (0.999, 1.001)0.607
    • ↵* Adjusted for encounter length, race, and insurance payer.

    • ↵† Model included a term for the interaction between time and high/medium/low referral clinic clusters.

    • View popup
    Table 4.

    Top Ten Specialty Referrals by Clinic Group (Visits/Month)

    OverallHigh ReferralMedium ReferralLow Referral
    • 1. Gastroenterology (20.1)

    • 1. PMR (36.9)

    • 1. Gastroenterology (14.1)

    • 1. Gastroenterology (13.9)

    • 2. PMR (15.6)

    • 2. Gastroenterology (34.6)

    • 2. PMR (11.1)

    • 2. Surgery (6.7)

    • 3. Surgery (13.0)

    • 3. Ophthalmology (29.6)

    • 3. Surgery (10.4)

    • 3. Cardiology (6.1)

    • 4. Ophthalmology (12.2)

    • 4. Surgery (24.1)

    • 4. Obstetrics and gynecology (10.4)

    • 4. Neurology (6.0)

    • 5. Obstetrics and gynecology (12.1)

    • 5. Obstetrics and gynecology (22.3)

    • 5. Ophthalmology (7.6)

    • 5. Obstetrics and gynecology (5.4)

    • 6. Neurology (9.7)

    • 6. Neurology (18.0)

    • 6. Otolaryngology (7.2)

    • 6. Otolaryngology (4.3)

    • 7. Cardiology (9.6)

    • 7. Cardiology (17.7)

    • 7. Neurology (7.2)

    • 7. Dermatology (4.1)

    • 8. Otolaryngology (7.8)

    • 8. Mental health (24.1)

    • 8. Cardiology (7.1)

    • 8. Urology (3.2)

    • 9. Dermatology (7.7)

    • 9. Otolaryngology (14.8)

    • 9. Dermatology (7.0)

    • 9. PMR (2.9)

    • 10. Mental health (6.6)

    • 10. Dermatology (14.5)

    • 10. Diabetes/endocrine (5.7)

    10. Diabetes/endocrine (2.7)
    • PMR, physical medicine and rehabilitation (includes rehabilitation, cardiac rehabilitation, and physical medicine and rehabilitation).

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The Journal of the American Board of Family   Medicine: 34 (6)
The Journal of the American Board of Family Medicine
Vol. 34, Issue 6
November/December 2021
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Referral Rates Vary Widely Between Family Medicine Practices
Hamza El Ayadi, Alpa Desai, Ross E. Jones, Elvira Mercado, Maribeth Williams, Benjamin Rooks, Peter J. Carek
The Journal of the American Board of Family Medicine Nov 2021, 34 (6) 1183-1188; DOI: 10.3122/jabfm.2021.06.210213

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Referral Rates Vary Widely Between Family Medicine Practices
Hamza El Ayadi, Alpa Desai, Ross E. Jones, Elvira Mercado, Maribeth Williams, Benjamin Rooks, Peter J. Carek
The Journal of the American Board of Family Medicine Nov 2021, 34 (6) 1183-1188; DOI: 10.3122/jabfm.2021.06.210213
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