ArticleBMC health services research2021
Understanding the factors that affect the appropriateness of rheumatology referrals.
Article in BMC health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
7 citing papers in PubMed, 8 citations in OpenAlex.
- Impact of an interdisciplinary digital consultation platform on general practitioner referrals for musculoskeletal symptoms: a stepped wedge cluster randomized trial.Family practice · 2025Trial
- Machine learning improves online self-referral for inflammatory rheumatic diseases: a registry-based validation study.Rheumatology international · 2026Article
- Improving osteoarthritis diagnosis and management in the primary care setting: a concise educational tool for primary care providers.BMC rheumatology · 2025Article
- Factors influencing referral among women attending post abortion care at tertiary hospitals in Northern Uganda.Scientific reports · 2025Article
- The journey of patients with musculoskeletal complaints in Europe: a cross-sectional European survey.Rheumatology international · 2025Article
- First contact physiotherapists: are they able to reduce the burden on rheumatology services? A critical review of the evidence base.Rheumatology advances in practice · 2024Review
- Machine learning-based improvement of an online rheumatology referral and triage system.Frontiers in medicine · 2022Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundReducing inappropriate referrals to specialists is a challenge for the healthcare system as it seeks to transition from volume to value-based healthcare. Given the projection of a severe shortage of rheumatologists in the near future, innovative strategies to decrease demand for rheumatology services may prove more fruitful than increasing the supply of rheumatologists. Efforts to increase appropriate utilization through reductions in capacity may have the unintended consequence of reducing appropriate care as well. This highlights the challenges in increasing the appropriate use of high cost services as the health system transitions to value based care. The objective of this study was to analyze factors affecting appropriateness of rheumatology services.
methodsThis was a cross-sectional study of patients receiving Rheumatology services between November 2013 and October 2019. We used a proxy for "appropriateness": whether or not there was any follow-up care after the first appointment. Results from regression analysis and physicians' chart reviews were compared using an inter-rater reliability measure (kappa). Data was drawn from the EHR 2013-2019.
resultsWe found that inappropriate referrals increased 14.3% when a new rheumatologist was hired, which increased to 14.8% after wash-out period of 6 months; 15.7% after 12 months; 15.5% after 18 months and 16.7% after 18 months. Other factors influencing appropriateness of referrals included severity of disease, gender and insurance type, but not specialty of referring provider.
conclusionsGiven the projection of a severe shortage of rheumatologists in the near future, innovative strategies to decrease demand for rheumatology services may prove more fruitful than increasing the supply of rheumatologists. Innovative strategies to decrease demand for rheumatology services may prove more fruitful than increasing the supply of rheumatologists. These findings may apply to other specialties as well. This study is relevant for health care systems that are implementing value-based payment models aimed at reducing inappropriate care.
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Registered trials
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