Finlay W, Mutran E J, Zeitler R R, Randall C S
University of Georgia, Athens 30602.
J Aging Health. 1990 May;2(2):261-81. doi: 10.1177/089826439000200207.
In this study we examine what factors determine whether patients seen in a Veterans Administration primary care clinic will be referred to specialty clinics. It is based on a 25% sample of all patients seen by the medical residents in one clinic over an 18-month period. Our dependent variable is whether the patient was referred for a consultation or not. We performed separate regression analyses for patients who visited the clinic with acute complaints, with chronic-flareup complaints, and with chronic-routine complaints. Within each of these three categories, we further subdivided our sample into patients under and over 65. In each of the six regression equations we controlled for the medical diagnosis and for each resident's work load, residency year, and training. Work load and residency year had opposite (and unpredicted) effects for patients over the age of 65 compared to those under the age of 65. Higher work loads were associated with higher consultation rates for patients over 65 and with lower rates for those under 65. Residency year had a negative effect on referrals for patients over 65 and a positive effect for patients under 65.
在本研究中，我们探讨了哪些因素决定了在退伍军人管理局初级保健诊所就诊的患者是否会被转诊至专科诊所。该研究基于一个诊所的医学住院医师在18个月内诊治的所有患者的25%样本。我们的因变量是患者是否被转诊进行会诊。我们对因急性病症、慢性病症急性发作和慢性常规病症前来就诊的患者分别进行了回归分析。在这三类患者中，我们又将样本进一步细分为65岁及以上和65岁以下的患者。在六个回归方程中的每一个方程里，我们都控制了医学诊断以及每位住院医师的工作量、住院年限和培训情况。与65岁以下的患者相比，工作量和住院年限对65岁及以上的患者产生了相反（且无法预测）的影响。工作量增加与65岁以上患者较高的会诊率相关，而与65岁以下患者较低的会诊率相关。住院年限对65岁以上患者的转诊有负面影响，对65岁以下患者的转诊有正面影响。
