Is specialist referral associated with more ED visits in diabetics?

January 01, 0001

Is specialist referral associated with more ED visits in diabetics?

Primary care providers sometimes struggle with if and when to refer complex diabetic patients to specialists. One possible result of the fragmentation of care after referral is more ED visits. These US researchers sought to evaluate patterns of fragmented care and emergency department (ED) use among patients with diabetes and chronic kidney disease. They performed an observational study, calculating a fragmentation of care index (range, 0- 1), with zero reflecting all care in 1 outpatient clinic and 1 reflecting each visit at a different clinic site. The authors used a negative binomial model to estimate the influence of fragmentation on ED use.

The authors report: "Of 3873 patients with diabetes having an established primary care provider, 623 (16.1%) had chronic kidney disease and comprised the final study sample. On average, patients made 19.0 outpatient visits and 1.2 ED visits over the 2-year period. The median fragmentation of care index was 0.48, 14.3% of subjects had a fragmentation of care index of zero. In the adjusted model, a 0.1-U increase in the fragmentation of care index was associated with a 15% increase in the number of ED visits (incidence rate ratio)."

The authors concluded: "The posited benefits of specialist referrals among patients with complex diabetes may be partially negated by care fragmentation. Better models for care coordination and stronger evidence of the marginal benefits of referrals are needed."

This study suggests that referral to a specialist may results in more emergency room visits due to fragmentation of care.

For the full abstract, click here.

American Journal of Managed Care 16(6)413-420, June 2010
© 2010 Managed Care & Healthcare Communications, LLC
Care Fragmentation and Emergency Department Use Among Complex Patients With Diabetes. Constance W. Liu, Doug Einstadter, and Randall D. Cebul. Correspondence to Constance W. Liu: [email protected]

Category: HSR Health Services Research Keywords: diabetes, primary care, specialist, fragmentation of care, ED visits, observational study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 13 July 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.