Is Self-Referral Associated with Higher Quality Care?

Health Serv Res. 2015 Oct;50(5):1472-90. doi: 10.1111/1475-6773.12289. Epub 2015 Mar 11.

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.

Keywords: Self-referral; colorectal cancer; lung cancer; referral.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Age Factors
  • Aged
  • Black or African American / statistics & numerical data
  • Colorectal Neoplasms / therapy*
  • Communication
  • Health Services Accessibility
  • Humans
  • Insurance, Health
  • 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 and Consultation / statistics & numerical data*
  • Sex Factors
  • Socioeconomic Factors
  • White People / statistics & numerical data