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Comparison of specialty referral rates in the United Kingdom and the United States: retrospective cohort analysis

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7360.370 (Published 17 August 2002) Cite this as: BMJ 2002;325:370

Data supplement

  • Table 1   Characteristics of study population ...

    Table 2  Actual and expected specialty referral rates ...

    Table 3   Specialty specific referral rates for patients with selected conditions ...
     

    Table 1 Characteristics of study population.* Values are numbers (percentages) unless stated otherwise
     

    Characteristic
    United States health plans
    United Kingdom general practice research database (n=757 680)
    Upper Mid-Atlantic plan (n=253 478)
    Midwestern plan A (n=20 549)
    Midwestern plan B (n=70 288)
    Northeastern plan (n=29 499)
    Lower Mid-Atlantic plan (n=10 869)
    Mean (SD) age (years) 
    29.1 (18.8)
    29.6 (18.4)
    32.7 (19.1)
    32.2 (19.1)
    29.8 (18.5)
    31.3 (18.4)
    Age distribution:
    0-17 years
    92 238 (36.4)
    7 551 (36.8)
    22 380 (31.8)
    9 221 (31.3)
    3 702 (34.1)
    221 312 (29.2)
    18-44 years
    96 189 (38.0)
    7 549 (36.7)
    23 250 (33.1)
    10 517 (35.6)
    4 360 (40.1)
    316 812 (41.8)
    45-64 years
    65 051 (25.7)
    5 449 (26.5)
    24 658 (35.1)
    9 761 (33.1)
    2 807 (25.8)
    219 556 (29.0)
    Female
    134 688 (53.1)
    10 611 (51.6)
    37 060 (52.7)
    16 059 (54.4)
    6 161 (56.7)
    398 920 (52.7)
    No of chronic conditions:
    0
    176 315 (69.6)
    16 308 (79.4)
    53 939 (76.7)
    19 411 (65.8)
    6 800 (62.6)
    581 840 (76.8)
    1
    56 667 (24.4)
    3 470 (16.9)
    12 895 (18.4)
    7 162 (24.3)
    2 702 (24.9)
    147 011 (19.4)
    2+
    20 496 (6.1)
    771 (3.8)
    3 454 (4.9)
    2 926 (9.9)
    1 367 (12.5)
    28 829 (3.8)
    Treated morbidity index group:
    1 (lowest/healthiest)
    39 992 (15.8)
    3 281 (16.0)
    13 325 (19.0)
    4 803 (16.3)
    1 546 (14.2)
    136 630 (18.0)
    2
    35 588 (41.7)
    8 918 (43.4)
    27 072 (38.5)
    10 389 (35.2)
    3 724 (34.3)
    276 260 (36.5)
    3
    105 633 (24.8)
    4 920 (23.9)
    16 740 (23.8)
    7 301 (24.8)
    2 705 (24.9)
    188 533 (24.9)
    4
    33 754 (13.3)
    2 364 (11.5)
    9 280 (13.2)
    4 736 (16.0)
    1 893 (17.4)
    92 878 (12.3)
    5
    5 968 (2.5)
    646 (3.1)
    2 182 (3.1)
    1 223 (4.2)
    511 (4.7)
    33 971 (4.5)
    6 (highest/sickest)
    5 329 (1.9)
    420 (2.0)
    1 689 (2.4)
    1 047 (3.6)
    490 (4.5)
    29 408 (3.9)
    Mean No of unique ICD-9 codes recorded by primary care physicians per person
    2.8
    3.0
    2.9
    3.1
    3.2
    3.0

    *Restricted to people aged 0-64 years with 6-12 months of enrolment on plan (US) or registration with general practice (UK) and at least one consultation with their primary care physician during the study period. Pregnant women were excluded.
     

    Table 2  Actual and expected specialty referral rates, United States and United Kingdom
     

    Referral rates and rate ratios
    United States health plans
    United Kingdom general practice research database (n=757 680)
    Upper Mid-Atlantic plan (n=253 478)
    Midwestern plan (n=20 549)
    Midwestern plan (n=70 288)
    Northeastern plan (n=29 499)
    Lower Mid-Atlantic plan (n=10 869)
    Actual referral rate (% (No) patients referred per year)
    30.0 (76 169)
    35.7 (7 341)
    34.9 (24 492)
    32.6 (9 632)
    36.8 (3 999)
    13.9 (105 072)
    Expected referral rate* (% patients referred per year)
    30.0
    29.7
    30.0
    31.8
    33.0
    31.2
    Ratio of actual to expected referral rate (95% CI)
    1.00
    1.20 (1.17 to 1.23)
    1.16 (1.14 to 1.17)
    1.02 (1.00 to 1.04)
    1.11 (1.08 to 1.15)
    0.44 (0.44 to 0.45)

    *Sicker populations have higher expected referral rates. Expected rates reflect what overall referral rate would be if the population had referral rates within adjusted clinical group categories equivalent to those of upper mid-Atlantic plan (reference population).
     

    Table 3  Specialty specific referral rates for patients with selected conditions, United States and United Kingdom
     

    Type of specialist
    Condition
    No of people with condition managed in primary care settings per 1000 population
     
    Referral rate (% with condition referred to indicated specialty)
    Difference in referral rates between US and UK (%)
    Combined US health plans (n=384 693)
    United Kingdom (n=757 680)
    Combined US health plans (n=384 693)
    United Kingdom (n=757 680)
    DermatologistDermatitis and eczema
    44
    87
     
    10.6
    2.8
    7.8*
     Acne
    12
    26
     
    14.8
    5.3
    9.5*
     Viral warts and molluscum contagiosum
    23
    26
     
    10.4
    4.9
    5.5*
    NeurologistSeizure disorder
    3
    7
     
    27.3
    6.1
    21.2*
    OtolaryngologistOtitis media
    131
    93
     
    6.8
    4.4
    2.4*
     Deviated nasal septum
    0.4
    0.5
     
    52.7
    42.8
    9.9
     Deafness, hearing loss
    3
    14
     
    28.8
    22.4
    6.4*
     Chronic pharyngitis and tonsillitis
    2
    1
     
    24.5
    29.6
    -5.1
    OphthalmologistStrabismus, amblyopia
    0.4
    2
     
    44.2
    32.6
    11.6*
     Disorders of the eyelid or lacrimal duct, excluding blepharitis, chalazion
    2
    9
     
    22.4
    9.6
    12.8*
     Refractive errors
    1
    0.8
     
    15.0
    18.2
    -3.2
    Orthopaedic surgeonLow back pain
    48
    101
     
    9.7
    4.6
    5.1*
     Cervical pain syndromes
    12
    35
     
    9.2
    3.4
    5.8*
    PsychiatristDepression, anxiety, neuroses
    46
    108
     
    7.5
    5.5
    2.0*
     Attention deficit disorder
    14
    0.4
     
    4.1
    9.4
    -5.3*
     Personality disorders
    0.2
    1
     
    17.4
    13.2
    4.2
    General surgeonAnorectal conditions
    11
    28
     
    18.7
    13.4
    5.3*
     Cholelithiasis, cholecystitis
    3
    4
     
    34.0
    14.5
    19.5*
     External abdominal hernias, hydroceles
    4
    9
     
    52.4
    27.0
    25.4*

    *P<0.01.
     

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