PCPs' referral decisions are influenced by a complex mix of patient, physician, and health care system structural characteristics. Factors associated with more discretionary referrals may lower PCPs' thresholds for referring problems that could have been managed in their entirety within primary care settings.
Disclosing a disability to a potential or current employer is a very personal decision, with potentially far-reaching consequences for both the employer and employee. Disability disclosure can assure that employees receive appropriate workplace accommodations, and can help employers respond more effectively to diversity and inclusion initiatives aimed at increasing the hiring and retention of individuals with disabilities. However, disclosure may also result in negative employment consequences for employees, such as lowered supervisor expectations, isolation from co-workers, and increased likelihood of termination. Given demographic trends related to disability in the labor force and recent initiatives to increase the employment of individuals with disabilities, it is increasingly important that employers create an environment that encourages disclosure and reduces the likelihood of negative consequences for employees and applicants who disclose their disabilities. This paper presents the findings of a survey of individuals with disabilities focused on identifying and better understanding the factors that influence the disclosure decision. Results highlight the barriers and facilitators that influence individuals' decision to disclose and the important role that employers, managers, and workplace climate play in the decision. Implications for employer policy and practice are also discussed.
Objectives: To describe how physicians coordinate patient care for specialty referrals and to examine the effects of these activities on referring physicians' satisfaction with the specialty care their patients receive and referral completion. Design and Methods:Prospective study of a consecutive sample of referrals (N = 963) made from the offices of 122 pediatricians in 85 practices in a national practicebased research network. Data sources included a physician survey completed when the referral was made (response rate, 99%) and a physician survey and medical record review conducted 3 months later (response rate, 85%). Referral completion was defined as receipt of written communication of referral results from the specialist.Results: Pediatricians scheduled appointments with specialists for 39.3% and sent patient information to specialists for 50.8% of referrals. The adjusted odds of referral completion were increased 3-fold for those referrals for which the pediatrician scheduled the appointment and communicated with the specialist compared with those for which neither activity occurred. Referring physicians' satisfaction ratings were significantly increased by any type of specialist feedback and were highest for referrals involving specialist feedback by both telephone and letter. Elements of specialists' letters that significantly increased physician ratings of letter quality included presence of patient history, suggestions for future care, follow-up arrangements, and plans for comanaging care; only the inclusion of plans for comanaging patient care was significantly related to the referring physicians' overall satisfaction. Conclusions:Better coordination between referring physicians and specialists increases physician satisfaction with specialty care and enhances referral completion. Improvements in the referral process may be achieved through better communication and collaboration between primary care physicians and specialists.Arch Pediatr Adolesc Med. 2000;154:499-506 W HEN SPECIALTY referrals are made, primarycarephysicians must coordinate service delivery across settings, multiple providers, and time to maintain a seamless continuum of care. Optimal coordination involves the documentation of patient care activities, interprovider communication, and the integration of service delivery into a single medical home.1,2 Breakdowns in coordination hold the potential for missed or delayed diagnoses and treatments, repeated or unnecessary testing, increased iatrogenic morbidity, adverse drug reactions, and increased risk of litigation. Integrating referral care with primary care is a complex and time-consuming process. The success of primary care physicians' coordination efforts depends on tasks that they and other providers perform. Williams et al 4,5 proposed 3 coordination events involved in the referral process: (1) the referring physician communicates reasons for the referral and relevant patient information to the specialist, (2) the specialist completes the referral by communicating findings to the ...
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Introduction As concerns grow that a thinning labor force due to retirement will lead to worker shortages, it becomes critical to support positive employment outcomes of groups who have been underutilized, specifically older workers and workers with disabilities. Better understanding perceived age and disability discrimination and their intersection can help rehabilitation specialists and employers address challenges expected as a result of the evolving workforce. Methods Using U.S. Equal Employment Opportunity Commission Integrated Mission System data, we investigate the nature of employment discrimination charges that cite the Americans with Disabilities Act or Age Discrimination in Employment Act individually or jointly. We focus on trends in joint filings over time and across categories of age, types of disabilities, and alleged discriminatory behavior. Results We find that employment discrimination claims that originate from older or disabled workers are concentrated within a subset of issues that include reasonable accommodation, retaliation, and termination. Age-related disabilities are more frequently referenced in joint cases than in the overall pool of ADA filings, while the psychiatric disorders are less often referenced in joint cases. When examining charges made by those protected under both the ADA and ADEA, results from a logit model indicate that in comparison to charges filed under the ADA alone, jointly-filed ADA/ADEA charges are more likely to be filed by older individuals, by those who perceive discrimination in hiring and termination, and to originate from within the smallest firms. Conclusion In light of these findings, rehabilitation and workplace practices to maximize the hiring and retention of older workers and those with disabilities are discussed.
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