Background/Purpose: Recently, there has been a dramatic increase in referrals made to pediatric rheumatologists (PR) for non-specific symptoms and test results rather than overt signs of inflammatory and/or autoimmune disease. This has increased time spent on non-rheumatologic conditions by the already limited number of PRs in the US. There are approximately 450 PR in the US; a 16% decrease in workforce by 2030 is predicted. Previous studies show that a large proportion of referrals to PR result in non-rheumatologic diagnoses. In the current study, an analysis of referral sources was conducted to identify provider characteristics to guide initiatives to improve the quality of referrals and better utilize PR expertise.

Methods: This study retrospectively reviewed new referrals made to the Albany Medical Center (AMC) PR program from 2021-2023. Training and specialty of referral providers, practice and patient characteristics were assessed. In addition, referral documents, notes, test results, and referring providers’ proposed diagnoses. Final diagnoses made by the PR were compared to those proposed by referring providers. Statistical analyses included descriptive statistics and Chi-square analyses. IRB approval was obtained for this study.

Results: A total of 1345 new referrals were identified over the 3 years. 257 charts were excluded mainly due to duplications (7), no referral in chart (154), internal AMC referral (48), and previous diagnoses (39). Of the 1088 included patients, 77.5% of referrals were from physicians and 22.5% were from advanced practice providers (APP). Of the included referrals, 40.2% led to definitive rheumatologic diagnoses, 55.3% led to non-rheumatologic diagnoses, and 5.5% were lost to follow up.
Rheumatologic diagnoses resulted from 41.9% of the 854 physician referrals compared to 34.1% of the 117 APP referrals, varying with a p-value of .034028.
Rheumatologic diagnoses resulted from 39.1% of the 800 pediatric referrals, 41.0% of the 117 family medicine referrals, and 54.7% of the 84 Orthopedic referrals, varying with a p-value .04554.

Conclusion: : Of new patients referred to AMC PR, 40% of the diagnosis were inflammatory or autoimmune. Pediatrics and Family Medicine Physicians, as well as APP’s, referred a greater proportion of patients with non-rheumatologic diagnoses. Our study suggests targeted education for Pediatric and Family Medicine physicians and APPs with increased emphasis on proper interpretation of tests, clinical history, and symptom presentation to most effectively utilize the limited time and access to PR expertise.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/referrals-leading-to-rheumatologic-diagnosis-in-a-pediatric-rheumatology-center-influence-of-referring-provider-practice-and-training/