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Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Is Self-Referral Associated with Higher Quality Care?

TitleIs Self-Referral Associated with Higher Quality Care?
Publication TypeJournal Article
Year of Publication2015
AuthorsPollack, CE, Rastegar, A, Keating, NL, Adams, JL, Pisu, M, Kahn, KL
JournalHealth Serv Res
Volume50
Pagination1472-90
Date PublishedOct
ISBN Number1475-6773 (Electronic)0017-9124 (Linking)
Accession Number25759002
KeywordsAfrican Americans/statistics & numerical data, Age Factors, Aged, colorectal cancer, Colorectal Neoplasms/*therapy, Communication, European Continental Ancestry Group/statistics & numerical data, Health Services Accessibility, Humans, Insurance, Health, lung cancer, Lung Neoplasms/*therapy, Medical Oncology/statistics & numerical data, Middle Aged, Neoplasm Staging, Physician-Patient Relations, Propensity Score, Quality Indicators, Health Care, Quality of Health Care/*statistics & numerical data, Radiation Oncology/statistics & numerical data, referral, Referral and Consultation/*statistics & numerical data, Self-referral, Sex Factors, Socioeconomic Factors
Abstract

OBJECTIVE: To assess the extent to which patients self-refer to cancer specialists and whether self-referral is associated with better experiences and quality of care. DATA SOURCES: Data from surveys and medical record abstraction collected through the Cancer Care Outcomes Research and Surveillance Consortium. STUDY DESIGN: Observational study of patients with lung and colorectal cancer diagnosed from 2003 through 2005 in five geographically defined regions and five integrated health care delivery systems. METHODS: Multivariable logistic regression models used to assess factors associated with self-referral and propensity score-weighted doubly robust models to test the association between self-referral and experiences/quality of care. PRINCIPAL FINDINGS: Among 5,882 patients, 9.7 percent of lung cancer patients and 14.9 percent of colorectal cancer patients self-referred to at least one cancer specialist. Black patients were less likely to self-refer than white patients (odds ratio: 0.48, 95 percent confidence interval: 0.35, 0.64); patients with high incomes (vs. low) and with a college degree (vs. non-high school graduates) were significantly more likely to self-refer. Self-referral was associated with lower ratings of overall physician communication for patients with lung cancer but, conversely, higher odds of curative surgery among patients with stage I/II lung cancer. CONCLUSIONS: A small but significant proportion of patients self-referred to their cancer specialists; rates varied by patient race and socioeconomic status. To the extent that self-referral is associated with quality, it may reinforce disparities in care.

PMCID

PMC4600357