Referral management and the care of patients with diabetes: the Translating Research Into Action for Diabetes (TRIAD) study.

摘要

OBJECTIVE:To examine the effect of referral management on diabetes care.STUDY DESIGN:Cross-sectional analysis.PATIENTS AND METHODS:Translating Research Into Action for Diabetes (TRIAD) is a multicenter study of managed care enrollees with diabetes. Prospective referral management was defined as "gatekeeping" and mandatory preauthorization from a utilization management office, and retrospective referral management as referral profiling and appropriateness reviews. Outcomes included dilated eye exam; self-reported visit to specialists; and perception of difficulty in getting referrals. Hierarchical models adjusted for clustering and patient age, gender, race, ethnicity, type and duration of diabetes treatment, education, income, health status, and comorbidity.RESULTS:Referral management was commonly used by health plans (55%) and provider groups (52%). In adjusted analyses, we found no association between any referral management strategies and any of the outcome measures.CONCLUSIONS:Referral management does not appear to have an impact on referrals or perception of referrals related to diabetes care.