ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2005
Case-mix and variation in specialist referrals in general practice.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2005. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- Cluster randomised trial on the effectiveness of a computerised prompt to refer (back) patients with type 2 diabetes.PloS one · 2018Trial
- More Indirect Patient Care Activities per Visit: 11-Year Analysis of Family Physician Electronic Health Records in Canada.Annals of family medicine · 2026Article
- Article
- Effects of GP characteristics on unplanned hospital admissions and patient safety. A 9-year follow-up of all Norwegian out-of-hours contacts.Family practice · 2022Article
- Use of hospital care services by chronic patients according to their characteristics and risk levels by adjusted morbidity groups.PloS one · 2022Article
- General practitioners referring patients to specialists in tertiary healthcare: a qualitative study.BMC family practice · 2019Article
- [Validity of adjusted morbidity groups with respect to clinical risk groups in the field of primary care].Atencion primaria · 2019Observational
- Influences of socioeconomic deprivation on GPs' decisions to refer patients to cardiology: a qualitative study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2018Article
- Practice variation in surgical procedures and IUD-insertions among general practitioners in Norway - a longitudinal study.BMC family practice · 2017Article
- Clinical outcome of head and neck cancer patients: a comparison between ENT patients referred via the 2 weeks wait pathway and alternative routes in the UK health system.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2017Article
- Design and Implementation of a Physician Coaching Pilot to Promote Value-Based Referrals to Specialty Care.The Permanente journal · 2017Article
- The new frontier in health services research: a behavioural paradigm guided by genetics.Journal of health services research & policy · 2017Article
- The primary-specialty care interface in chronic diseases: patient and practice characteristics associated with co-management.Healthcare policy = Politiques de sante · 2014Article
- Examining the variation in GPs' referral practice: a cross-sectional study of GPs' reasons for referral.The British journal of general practice : the journal of the Royal College of General Practitioners · 2014Article
- Keep it simple? Predicting primary health care costs with clinical morbidity measures.Journal of health economics · 2014Article
- Relationship between efficiency and clinical effectiveness indicators in an adjusted model of resource consumption: a cross-sectional study.BMC health services research · 2013Article
- Adverse events recorded in English primary care: observational study using the General Practice Research Database.The British journal of general practice : the journal of the Royal College of General Practitioners · 2013Observational
- Distance to hospital and socioeconomic status influence secondary health care use.Scandinavian journal of primary health care · 2013Article
- High referral rates to secondary care by general practitioners in Norway are associated with GPs' gender and specialist qualifications in family medicine, a study of 4350 consultations.BMC health services research · 2013Article
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4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe potential of a comprehensive measure of patient morbidity to explain variation in referrals to secondary care has not previously been examined in the UK.
aimTo examine the relative role of age, sex and morbidity as defined by the Johns Hopkins ACG Case-Mix System in explaining variations in specialist referrals in general practice. DESIGN OF STUDY: Retrospective study of a cohort of patients followed for 1 year.
settingTwo hundred and two general practices, with a total list size of 1,161,892, contributing data to the General Practice Research Database.
methodEach patient was assigned an ACG and morbidity group, based on their diagnoses, age and sex. The variability in referrals explained by these factors was examined using multilevel logistic regression models by splitting it into variation between practices and variation between patients within practices.
resultsThe annual median (range) percentage of patients referred was 14.8% (range = 2.4-24.4%). The percentage of patients referred increased with age and morbidity. Morbidity explained 30.4% of the total variation in referrals (composed of variability between and within practices). Age and sex only explained 5.3% of the total variation. The variation attributable to practices was approximately 5%, thus most of the variation occurred within practices. Morbidity was also identified as a better predictor of referral compared to age and sex.
conclusionsMorbidity explains almost six times more of the variation in general practice referrals than age and sex, although about two-thirds of the variation remains unexplained. Most of the unexplained variation is due to differences within rather than between practices. The amount of variability in referrals between practices may be less than implied by previous studies based on aggregate information. The implications are that any investigation of specialist referrals from general practice should be interpreted cautiously, even after adjustment for age, sex and morbidity.
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Identifiers
16004738PMC1472770What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.