MANUSCRIPT: Dropping the Baton: Specialty Referrals in the United States – MEHROTRA – 2011 – Milbank Quarterly – Wiley Online Library
Findings: PCPs vary in their threshold for referring a patient, which results in both the underuse and the overuse of specialists. Many referrals do not include a transfer of information, either to or from the specialist; and when they do, it often contains insufficient data for medical decision making. Care across the primary-specialty interface is poorly integrated; PCPs often do not know whether a patient actually went to the specialist, or what the specialist recommended. PCPs and specialists also frequently disagree on the specialist’s role during the referral episode (e.g., single consultation or continuing comanagement).