This project has three major aims: (1) to characterize patterns of physician referrals and consultations in the treatment of non-institutionalized elderly and disabled Medicare beneficiaries; (2) to identify correlates of referral and consultation patterns found in the course of addressing the first study objective; and (3) to identify differences in cost and clinical outcomes associated with specialist referrals for the treatment of cardiovascular disease in the Medicare population. The study will use data from the Medicare claims records and beneficiary responses to the 1992, 1993, and 1994 Medicare Current Beneficiary Surveys (MCBS) to produce descriptive cross-tabulations of referrals contrasted with various relevant factors of beneficiaries and physicians. Profiles to be developed include physician visits and referral status for various beneficiary demographic characteristics; frequency of referrals and consultations by patient health status (e.g., activities of daily living [ADL] score, diagnosis, and level of health services utilization); referrals by place of visit and characteristics of geographical areas; and referrals and consultations by physician characteristics. The second phase of the project would involve multivariate analysis of correlates of referral and consultation to determine which factors are predictive of referral and consultation visits. The final phase of the project will investigate how specialty referrals for cardiovascular disease influence resource utilization and patient outcomes (as measured by risk of death, hospitalization, and other potentially avoidable consequences of treatment failure).
