Referral management and the care of patients with diabetes: The Translating Research into Action for Diabetes (TRIAD) study

Objective: To examine the effect of referral management on diabetes care. Study Design: Cross-sectional analysis. Patients and Methods: Translating Research Into Action for Diabetes (TRIAD) is a multicenter study of managed care enrollees with diabetes. Prospective referral management was defined as "gatekeeping" and mandatory preauthorization from a utilization management office, and retrospective referral management as referral profiling and appropriateness reviews. Outcomes included dilated eve exam; self-reported visit to specialists; and perception of difficulty in getting referrals. Hierarchical models adjusted for clustering and patient age, gender, race, ethnicity, type and duration of diabetes treatment, education, income, health status, and comorbidity. Results: Referral management was commonly used by health plans (55%) and provider groups (52%). In adjusted analyses, we found no association between any referral management strategies and any of the outcome measures. Conclusions: Referral management does not appear to have an impact on referrals or perception of referrals related to diabetes care.