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  • The Patient Referral Network – Understanding Where Surgical Volume Comes From in a Complex Referral System

    Final Number:

    Eric Herring; Caroline E. Vonck BS; Matthew R. Peck BS; Gabriel Alexander Smith MD; Joseph E Tanenbaum BA; Thomas E. Mroz MD; Michael P. Steinmetz MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Prior studies have evaluated proportions of patients referred by general practitioners (GP) to subspecialty providers. However, few studies have evaluated referral patterns of patients to spine surgeons and none have determined the likelihood of surgery from referral sources. This study aimed to identify the common referral patterns at a large, tertiary care, academic, medical center that led to spine surgery.

    Methods: This study is a retrospective cohort study, that examined patients referred to one of five spinal surgeons in the Cleveland Clinic Center for Spine Health for the first time from 2011-2016. Surgical status, demographics, and referral source were gathered for each patient.

    Results: Of 2,448 new visits, 1487 (60.7%) met inclusion criteria. For all referral sources, 44.9% underwent surgery. 55.2% of referrals were self-referrals, while 44.8% were referred by a physician. Self-referred patients were less likely than physician-referred patients to undergo surgery (OR 0.48, 95% CI 0.39-0.59, p<0.0001). The most common referral specialty categories were GP (49.8%), Interventionalists (19.1%), Surgery (12.5%), and Neurology (10.7%). Of these specialties, referrals from Interventionalists (OR 1.64, 95% CI 1.09-2.45, p=0.0163) and Neurology (OR 2.02, 95% CI 1.19-3.44, p<0.0082) were more likely to lead to surgery. Those referred by GP were less likely to undergo surgery (OR 0.55, 95% CI 0.40-0.76, p=0.0003). After accounting for covariates, self-referred (OR 0.68, 95% CI 0.48-0.96, p=0.0293), GP (OR 0.56, 95% CI 0.38-0.83, p=0.0036), physician-referred (OR 1.48, 95% CI 1.04-2.10, p=0.0293), and Neurology (OR 1.75, 95% CI 1.01-3.05, p=0.0477) were predictors of undergoing surgery.

    Conclusions: This study found self-referred and GP-referred patients underwent surgery less often than Neurology or Interventionalist referred patients. This information may help spine surgeons evaluate referral patterns to optimize patient throughput and maximize provider efficiency.

    Patient Care: This information should help spine surgeons evaluate their referral patterns in order to optimize patient throughput, selection, and maximize provider efficiency. If spine surgeons are able to increase their provider efficiency, this would improve patient care by increasing the number of patients that are able to have surgery and by decreasing the time to treatment for patients.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the various trends in referral provider sources for spine surgeons presented based on a large tertiary health center 2) Discuss the differences in undergoing surgery based on provider source and 3) Identify differences within provider specialties in terms of surgical status


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