Showing papers on "Referral published in 1987"

Social Ties and Word-of-Mouth Referral Behavior

Abstract: This article presents a network analysis of word-of-mouth referral behavior in a natural environment. The relational properties of tie strength and homophily were employed to examine referral behavior at micro and macro levels of inquiry. The study demonstrates different roles played by weak and strong social ties. At the macro level, weak ties displayed an important bridging function, allowing information to travel from one distinct subgroup of referral actors to another subgroup in the broader social system. At the micro level, strong and homophilous ties were more likely to be activated for the flow of referral information. Strong ties were also perceived as more influential than weak ties, and they were more likely to be utilized as sources of information for related goods.

The volume-outcome relationship: practice-makes-perfect or selective-referral patterns?

Abstract: Various studies have demonstrated that hospitals with larger numbers of patients with a specific diagnosis or procedure have lower mortality rates. In some instances, these results have been interpreted to mean that physicians and hospital personnel with more of these patients develop greater skills and that this results in better outcomes--the "practice-makes-perfect" hypothesis. An alternative explanation is that physicians and hospitals with better outcomes attract more patients--the "selective-referral pattern" hypothesis. Using data for 17 categories of patients from a sample of over 900 hospitals, we examine the patterns of selected variables with respect to hospital volume. To explore the plausibility of each hypothesis, a simultaneous-equation model is also used to test the relative importance of the two explanations for each diagnosis or procedure. The results suggest that both explanations are valid, and that the relative importance of the practice or referral explanation varies by diagnosis or procedure, in ways consistent with clinical aspects of the various patient categories.

Informal Job Search and Black Youth Unemployment

Abstract: In this paper I analyze how young black and white unemployed jobseekers use various methods of search, and the employment outcomes which result from their useThe focus is on distinguishing informal search methods (ie,friends and relatives or direct application without referral) from more formal ones in analyzing racial differencesThe results show that the two informal methods of search account for about 90% of the difference in employment probabilities between white and black youth This also accounts for 57-71% of the difference in unemployment rates between the two Furthermore, most of these results reflect differences in the ability of these methods to generate job offers, as opposed to differences in search effort or job acceptance rates However, our ability to explain these differences through personal, family, and household characteristics was generally quite limited

Correlates of Depression and Burden for Informal Caregivers of Patients in a Geriatrics Referral Clinic

Abstract: Caregiver burden has been associated with patient dementia. In this study we tested the hypothesis that caregiver burden and depression are related to patient cognitive impairment. We analyzed records of 127 elderly male patients from a Veterans hospital geriatrics referral clinic. The patients and their informal caregivers had been referred to the clinic because the complexity and multiplicity of their problems were beyond the treatment capability of other clinics. There was a high prevalence of dementia (73%) and depression (69%) in these patients according to Diagnostic and Statistical Manual (DSM-III) criteria. Quantitative measures of patient dementia and dependency in activities of daily living were not statistically associated with measures of caregiver depression or burden. In contrast, measures of patient depression were significantly correlated with measures of caregiver depression and burden. We hypothesize that caregivers of chronically ill, elderly men cope better with physical and cognitive incapacity than with affective symptoms. Because caregiver support is the most important factor in maintaining a disabled elder in the community, we suggest evaluating patients and caregivers for depression as part of standard practice in geriatric clinical settings.

Sex Differences in Help‐seeking for Alcohol Problems—2. Entry into Treatment

Abstract: Summary A sample of 25 men and 25 women, referred to a specialist alcohol clinic, was interviewed to obtain information about perceptions of the ‘barriers’ to treatment entry and of the events and circumstances seen as influencing decisions to attend the clinic. A semi-structured interview schedule was used and interviews were tape recorded. Perceptions of the ‘barriers’ to treatment were described in an earlier paper. This paper reports on patients' accounts of the part played by life events and difficulties, and by other people on clinic attendance. Current difficulties, affecting patients at the time of entry into treatment are described and patients' perceptions of the main reason for treatment entry are reported. The study indicates that few patients had accepted referral to the clinic primarily because they wanted to change their drinking behaviour. Rather they hoped to alleviate other problems in their lives. Some differences were found between men and women in their experiences of life events in the preceding 12 months but not in their perceptions of the influence of life events on decisions to seek help. There were also some sex differences in the reporting of current difficulties in the main reason for treatment entry and in perceptions of the influence of others on clinic attendance.

Prognostic conflict in life-and-death decisions: the organization as an ecology of knowledge.

Abstract: This paper examines prognostic conflict in life-and-death decisions in intensive care units for newborn infants. The data were collected during 16 months of field research in two intensive care nurseries which differed with respect to their size, relative prestige, referral patterns, and the demographic composition of their clientele. This analysis approaches life-and-death decisions from the standpoint of the sociology of knowledge, which relates decisions to the social context in which they take place. Prognostic conflict is used as a paradigmatic case to illustrate how the organization as an ecology of knowledge allocates different information to those who reach life-and-death decisions. A major finding is that physicians and nurses, because of their experiences in the intensive care nursery, differ systematically in their views of infants' prognoses. Residents, whose contact with infants is limited and technologically focused, assess prognosis largely on the basis of diagnostic technology. Nurses, who sustain continuous contact with infants, also assess prognosis on the basis of cues gleaned from interactions with infants, but may assume a more pessimistic attitude toward infants who pose management difficulties. These contrasting and "partial" views of reality are rooted in the culture and social structure of technology-intensive medical settings. Following medical historians, we suggest that medical practice has been characterized by a diminishing attention to patients' subjective symptoms, a waning confidence in clinical observation, and an increasing reliance on diagnostic technology. These organizational features of neonatal intensive care units complicate life-and-death decisions. By implication, a change in some of these features might result in more informed and equitable decision-making.

Explaining variation in general practitioner referrals to hospital.

Abstract: Reported rates of referral by individual general practitioners to hospitals range from less than 1% of all consultations to more than 20%. Research on variations in rates of referral by general practitioners in the UK is reviewed here. Studies have largely failed to account for variation either in terms of differences in the characteristics of patients or differences in the doctors and their practices. It is argued that this failure arises because most studies do not distinguish between different types of referral or reasons for making a referral. In order to begin to explain variations it is necessary to identify the stages in the complex process of decision making. A theoretical model of the referral decision is advanced, which is intended to provide a framework for further research on the referral process.

Over- and undercontrolled referral problems among children and adolescents from Thailand and the United States: the wat and wai of cultural differences.

Abstract: To understand children's psychological problems and corresponding clinic referral patterns, we need to consider the impact of culture. Culturally mediated values and socialization practices may suppress development of some problems and foster others. Consider Thailand, a Buddhist nation, in which children's aggression and other undercontrolled behaviors are disapproved and discouraged, whereas their inhibition and other overcontrolled behaviors may often be condoned or even encouraged. We compared Thailand to the United States, where undercontrolled behavior among children seems more likely to be condoned. We recorded the behavior problems reported by parents in both countries (N 760) when they referred their child or adolescent for clinic treatment. Overcontrolled problems (e. g., somaticizing, fearfulness, nervous movements, worrying) were reported much more often for Thai than for U.S. youngsters; undercontrolled problems (e. g., disobedience, fighting, lying, arguing) were reported much more often for U.S. youth than for Thais. Overcontrolled problems were noted especially often among Thai adolescents, the group most exposed to traditional Buddhist teaching and most encouraged to inhibit outward expression of feelings. The findings sugest that culture, developmental level, and their interplay may be linked to substantial differences in the problems for which youngsters are referred for treatment.

Variation in general practitioners' referral rates to consultants.

Abstract: The variation in the number of patients general practitioners refer to hospital is a source of concern because of the costs generated and the implications for quality and quantity of care This paper compares 32 general practitioners with high referral rates with 35 doctors with low referral rates drawn from a study of 201 doctors. The mean referral rate for all 201 doctors was 6.6 per 100 consultations – for those with high referral rates the mean was 11.8 and for those with low referral rates 2.9. Differences between doctors with high and low referral rates with respect to age, sex, social class and diagnostic case mix of patients consulting were small. Doctors with high referral rates referred more patients in all categories. There were also few differences between the two groups with respect to the characteristics of the doctors themselves or their practices. The findings are discussed in the context of proposals to provide general practitioners with information on their own referral rates compared with those of other doctors.

The Effects of Disease Verification and Referral on the Relationship Between Symptoms and Diseases

Abstract: Reference symptoms of individual diseases, which are usually gleaned from hospital-based observations, may not be pertinent to primary health care. Observed relationships between symptoms and diseases can be biased by consultation, disease verification, and referral patterns. These biases are shown to affect sensitivity, specificity, predictive values, the likelihood ratio, and the odds ratio. On the assumption that consultation and disease verification rates are positively influenced by symptoms, but not directly by the yet unknown disease status of the patient, the general practitioner will observe a higher sensitivity and a lower specificity than in an unselected population. A positive correlation between symptom and disease will decrease the likelihood ratio, while the predictive values and the odds ratio are not changed after consultation. Referral is influenced by both symptom status and disease verification status. In general, the disease verification and referral patterns of general practitioners have not been quantified. While the influence of referral cannot easily be corrected for, the likely magnitude and direction of selection bias can be evaluated using simple formulas. A possible way to make unbiased estimations from populations preselected by referral is to compute the predictive values and the odds ratio from the category of patients referred without pre-existing knowledge of the disease status.

Patient dumping. Status, implications, and policy recommendations.

Abstract: DURING the past five years, there have been dramatic increases in patient dumping throughout the United States. Patient transfers increased from 70 per month in 1982 to more than 200 per month in 1983 in Dallas 1 ; from 169 per year to 930 per year from 1981 to 1985 in Washington, DC ( Washington Post , Feb 27,1986, p A14); and, in Chicago, from 1295 per year in 1980 to 5652 per year in 1984. Initial reports of this escalating problem were from large urban public hospitals, and it has now also been reported in smaller cities and rural areas ( Wall Street Journal , March 8, 1985, p 27). 2-4 Patient dumping has been recently documented at more than 40 public hospitals in Texas alone. 5 We define patient dumping as the denial of or limitation in the provision of medical services to a patient for economic reasons and the referral of that patient

A nurse practitioner in general practice: working style and pattern of consultations

Abstract: The work of a specially trained nurse practitioner, to whom patients had open access, was studied in an inner city general practice over a period of six months in 1983. A total of 858 patients of all ages and ethnic origins sought consultations for 979 problems. Morbidity from every diagnostic group was presented but the majority of the problems (60.4%) fell into the 'Supplementary' group: preventive medicine; health instruction and education; social, marital and family problems; administrative procedures. The consultation room setting and the long appointment times available (20 minutes) may partly account for this. Additional problems, mostly concerning health education, were raised in 46.0% of consultations. Most patients chose a consultation with the nurse practitioner appropriately and in more than one-third of all consultations the nurse managed the presenting problem without further referral for investigation, prescription or other medical advice. It is concluded that nurses have a much larger and more autonomous part to play in the care of patients than hitherto.

Evaluation of public health preschool child developmental screening: the process and outcomes of a community program.

Abstract: We conducted a randomized controlled trial of a public health and education screening program aimed at all 4,797 four to five year old children registering for kindergarten in three school districts of southern Ontario, Canada. Children received either the Denver Developmental Screening Test (DDST) with a community health intervention program for positive screeness; the DDST with no intervention for positive screenees; or no screening test. The intervention program consisted of referral to the child's physician for assessment; a review conference between the child's teacher and the school health nurse; parent counseling; and monitoring of the child in school by the school health nurse. At the end of the third school year, no differences were found between positive screenees in the community health intervention group and the "no intervention" groups using individual academic achievement, cognitive, and developmental tests. Parents' reports revealed no differences between groups in children's mental, social...

Referral to Hospital: Perceptions of Patients, General Practitioners and Consultants About Necessity and Suitability of Referral

Abstract: A sample of new referrals from general practitioners to hospital specialists was examined from the points of view of the patient, general practitioner and consultant concerned with regard to the adequacy of the general practitioners' performance before referral, his ability to have managed without referral and the suitability of the specialist seen. Little agreement was found between the opinions expressed by the three groups, although some of the opinions expressed within the groups were found to be associated with characteristics of the groups.

Toward Full Disclosure of Referral Restrictions and Financial Incentives by Prepaid Health Plans

Abstract: Prepaid plans provide an increasingly large share of today's health care in the United States. At present, 27.7 million people are enrolled in health maintenance organizations (HMOs), as compared w...

One hundred alcoholic women in medicine. An interview study.

Abstract: To examine the patterns of diagnosis, referral, and help-seeking behaviors of alcoholic women physicians, 95 women physicians and five women medical students were interviewed. Both groups were self-described alcoholics and members of Alcoholics Anonymous and were abstinent from alcohol for at least one year. Subjects participated in one-hour interviews with a recovered alcoholic professional woman. Addictions to drugs other than alcohol were common, with only 40% reporting addiction to alcohol alone. Seventy-three reported serious suicidal ideation prior to sobriety, 26 after the drinking ended. Thirty-eight had made overt suicide attempts, 15 more than once. The presence of alcoholics in the nuclear family and marital instability were common. Treatment experiences varied from none other than Alcoholics Anonymous (21%) to long-term residential treatment of 15 weeks or more per episode (23%). Most had reached treatment through circumstances other than referral by therapists or intervention by impaired-physician committees. Their current procedures should be evaluated with the particular needs of women in mind. ( JAMA 1987;257:2939-2944)

Child care and corporate productivity : resolving family/work conflicts

Abstract: An enlightening book--subtitled Resolving Family/Work Conflicts--that finally proves that the conflicts employees have between work and family do hinder overall productivity, and explains what employers can do to solve the problem. The author offers workable solutions including flexible work options, referral services and training programs, subsidized day-care, and job-sharing.

Outpatient consultation: interaction between the general internist and the specialist.

Abstract: To define the process of outpatient consultation, the authors conducted a prospective study of 716 consecutive outpatient consultations in a university-based primary care internal medicine practice. The overall consultation rate was 11.9 per 100 patient visits, with 78% of the referrals to other physicians and 22% to non-physician specialists. Consultation rates and patterns of referral varied little between physicians with different levels of experience. Eighteen per cent of the consultations resulted in a no-show by the patient to the consultant. Referring physicians received communications from the consultants 80.5% of the time when appointments were kept. By multivariate regression two variables were shown to be most important in determining the internist's overall satisfaction: 1) how well the consultant aided the internist in his ongoing management of the patient's problem, and 2) how well specific questions were addressed by the specialist. Other statistically significant variables were the clarity and promptness of the consultant's reply, the educational value of the consultation, and specific management recommendations made by the consultant. To improve the consultation process no-shows must be minimized, communication from the consultant maximized, and the interaction between the internist and the consultant bolstered.

Improving Compliance for Asthmatic Patients Visiting the Emergency Department Using a Health Belief Model Intervention

Abstract: The sample included 74 asthmatic patients presenting to an emergency department with an acute asthmatic attack. The purposes of the study were: to assess demographic and situational variables associated with compliance, and to test the impact of a Health Belief Model (HBM) intervention to increase compliance. Compliance was operationalized as making and/or keeping a follow-up referral appointment for the patient's asthmatic condition. Demographic and situational variables associated with compliance included age, sex, marital status, previous treatment experience, seriousness of the asthmatic condition, and need for child care. Most important, the HBM intervention was very effective in increasing compliance in both making and keeping a follow-up referral appointment.

The Teacher Assistance Team: A Pre-Referral Support System.

Abstract: The national focus in education is toward greater emphasis on remedial programs, concern over student failure, and the classroom teacher's role in effective instructional activities. To address these needs, educational personnel must coordinate their efforts to ensure that all students who are experiencing failure are afforded individualized, supportive instructional alternatives within the regular classroom setting. The utilization of teacher assistance teams is a powerful prototype to accomplish this noble-and attainable-goal of an appropriate education for all. Recent writing has highlighted the need to address the ever widening gap between regular and special education, particularly in response to the burdensome number of children with learning problems in regular and special education (Sheppard, 1987; Lilly, 1987; Hagerty & Abramson, 1987). The urgency of readdressing failure in the regular classroom, and the ability of teachers to meet escalating needs, is exemplified by the current national focus on educational reform, excellence, and accountability (e.g., teacher competency testing). Yet another concern of regular educators seeking supportive educational assistance from special education is that many students do not meet eligibility requirements to receive special services. This problem is national in scope. Therefore, the solution requires a vehicle for change that can be applied to any school in the country. The teacher assistance team (TAT) offers one solution. A pre-referral support system, the TAT is directed at eliminating the gap in services in general education while also \"filling in the cracks\" through which too many children fall when present methods are unable to facilitate a variety of educational alternatives for them. The TAT represents a step toward meeting the individual needs of each student who experiences educational problems in the regular classroom environment.

Physician Referrals in a Competitive Environment: An Estimate of the Economic Impact of a Referral

Abstract: Beyond offering optimum care for individual patients, physician referrals have a cumulative economic impact on many components of the broader medical care system. This article offers an approximation of the magnitude of that impact. By retrospectively reviewing financial records associated with 225 referrals from fee-for-service, rural family practice sites to university-based specialist colleagues, we found that the average referral generated $2944 in combined hospital charges and professional fees within a six-month period after referral. Almost half (110/225, or 49%) of those referrals resulted in a hospital admission and 72% of all revenue associated with referral accrued to the hospital. A second and more detailed study of 97 referrals showed that only 18% of total revenue resulting from referrals accrued to the physician to which the patient was initially referred. We argue that control over volume and destination of referrals, historically the referring physician's prerogative, is susceptible to change in our rapidly restructuring medical care system. In the future, no economic entity that benefits from physician referrals should take for granted those referrals or their impact. ( JAMA 1987;258:1920-1923)

The impact of a liaison psychiatry service on patterns of referral in a general hospital.

Abstract: A retrospective study of psychiatric referrals from a general hospital inpatient population was carried out for three separate years, 1973, 1976 and 1979. Reorganisation of the liaison service to the responsibility of one consultant team was associated with changes in referral rate and disposal. In particular, there was a significant increase in the referral rate of patients from medical and surgical wards who were not involved in acts of deliberate self-harm.

Information-seeking strategies and differences among primary care physicians.

Abstract: Differences in the sources of information that physicians utilize in their practice have several implications for the quality of care delivered and the dissemination of medical information. In order to examine the extent of differences in information preferences in primary care settings, 98 general internal medicine physicians and 73 family physicians were asked to indicate which of six alternative information sources they relied on most when faced with difficult medical problems. The alternatives were: journals, textbooks, informal consultations with colleagues, consultations with community specialists, consultations with outside specialists, and transfer of the patient to another physician. The results indicated that primary care internists have a greater preference for consulting the medical literature, while family physicians more often rely on colleagues and specialists as sources of information. These differences suggest that the focus of information dissemination through journals or textbooks may be more effective for internists, while colleagues or "educationally influential" physicians in the community may be more effective vehicles for information dissemination to family physicians.

Current referral practices of mental health care providers.

Abstract: Psychiatric referral practices of the clergy, primary care physicians, and mental health care specialists are examined in relation to the three stages of the referral process: the identification of a mental health problem, the decision to refer, and the selection of a treating professional. Referral practices within health maintenance organizations are also described to illustrate how organizational structure affects this process. Based on a literature review, the authors identify and discuss ten major factors that shape and define all referrals. They are the practitioner's capacity to recognize and define mental illness, the availability of resources, economic incentives, the amount of clinical information available, patient attitudes toward referral, the practitioner's therapeutic background, the practitioner's role perception, practitioner-patient interaction, interpractitioner relations, and provider group influences. The authors end with a critique of current mental health referrals.