Comparing the quality of referrals of general practitioners with high and average referral rates: an independent panel review

Abstract

The quality of referrals of four general practitioners, two with high and two with average rates of referral to the department of internal medicine, was judged by an independent expert panel. The panel, consisting of two general practitioners and one specialist, reviewed a set of information about the referrals blindly and in random sequence. The same distribution of quality of referrals was found among the referrals of the two high referring general practitioners (n = 192) as among those of the general practitioners with average rates (n = 88); that is, 57% and 55% respectively, of the cases had clear medical indications for referral, while the data did not permit a conclusion in 15% and 10%, respectively, of the cases. Controlling for sex, age and status of the referral (first or repeat referral) did not alter the results. We conclude that using referral rates to judge referral quality is misleading. However, a blind and randomly performed panel review of referrals is a time consuming but feasible method of quality assessment.