Hooker R S, Brown J B
Kaiser Permanente Center for Health Research, Portland, OR.
HMO Pract. 1990 Mar-Apr;4(2):61-5.
The authors studied the characteristics of patients referred for rheumatology consultation in a group model HMO. Six hundred twelve patients were evaluated in 1986. The ages ranged from 3 to 85 years, with an average of 52 years. Female patients outnumbered male patients almost 3:1. Only 44% of referrals had a presumptive diagnosis and more than one half of these diagnoses were changed by the consulting rheumatology specialist, suggesting a high value added from the HMO rheumatologic consultation. Internists referred at a slightly higher rate than family practitioners, and pediatricians referred children at one tenth of the adult rate. Comparison with other published data on fee-for-service rheumatology practices indicates that in one group model HMO, which prohibits patient self-referral, rheumatologic specialists see a higher percentage of patients with vague or difficult-to-manage conditions such as the connective tissue diseases and fibromyalgia and a lower percentage of osteoarthritis and gout. This finding suggests that the structure and incentives of HMOs alter medical referral and practice patterns in significant ways.
作者研究了在一个团体模式的健康维护组织（HMO）中被转诊至风湿病门诊的患者特征。1986年对612名患者进行了评估。年龄范围为3至85岁，平均年龄为52岁。女性患者数量几乎是男性患者的3倍。仅有44%的转诊患者有初步诊断，其中超过一半的诊断被会诊的风湿病专科医生更改，这表明HMO的风湿病会诊附加值很高。内科医生的转诊率略高于家庭医生，而儿科医生转诊儿童的比例是成人的十分之一。与其他关于按服务收费的风湿病诊疗的已发表数据相比，表明在一个禁止患者自行转诊的团体模式HMO中，风湿病专科医生诊治的患有结缔组织病和纤维肌痛等症状模糊或难以处理疾病的患者比例较高，而骨关节炎和痛风患者的比例较低。这一发现表明，HMO的结构和激励措施在很大程度上改变了医疗转诊和诊疗模式。
