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VOLUME 50 | NUMBER 5 | OCTOBER 2015


Is Self-Referral Associated with Higher Quality Care?

Keywords: Self-referral; referral; lung cancer; colorectal cancer

Objective: To assess the extent to which patients self-refer to cancer specialists and whether self-referral is associated with better experiences and quality of care.

Data Sources: Data from surveys and medical record abstraction collected through the Cancer Care Outcomes Research and Surveillance Consortium.

Study Design: Observational study of patients with lung and colorectal cancer diagnosed from 2003 through 2005 in five geographically defined regions and five integrated health care delivery systems.

Methods: Multivariable logistic regression models used to assess factors associated with self-referral and propensity score-weighted doubly robust models to test the association between self-referral and experiences/quality of care.

Principal Findings: Among 5,882 patients, 9.7 percent of lung cancer patients and 14.9 percent of colorectal cancer patients self-referred to at least one cancer specialist. Black patients were less likely to self-refer than white patients (odds ratio: 0.48, 95 percent confidence interval: 0.35, 0.64); patients with high incomes (vs. low) and with a college degree (vs. non-high school graduates) were significantly more likely to self-refer. Self-referral was associated with lower ratings of overall physician communication for patients with lung cancer but, conversely, higher odds of curative surgery among patients with stage I/II lung cancer.

Conclusions: A small but significant proportion of patients self-referred to their cancer specialists; rates varied by patient race and socioeconomic status. To the extent that self-referral is associated with quality, it may reinforce disparities in care.

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