Practice variation in physician referral for allogeneic hematopoietic cell transplantation

Bone Marrow Transplant. 2013 Jan;48(1):63-7. doi: 10.1038/bmt.2012.95. Epub 2012 Jun 18.


Hematological malignancy patients not referred by their primary hematologist/medical oncologist suffer disparate access to allogeneic hematopoietic cell transplantation (HCT). However, investigation into physician, system and patient factors relevant to this decision making is lacking. We surveyed a national randomized sample of practicing hematologists/medical oncologists identified through the AMA (American Medical Association) masterfile. A modified Dillman approach was utilized to encourage survey response. From 1200 surveyed, a total of 113 physicians responded. In all, 68% were male, 62% identified as White/non-Hispanic, 79% practiced in non-academic settings and 80% reported spending 75-100% of their professional effort in clinical care. Using clinical vignettes, we detected significantly increased odds for HCT non-referral according to age (age 60 vs 30, odds ratio (OR) 8.3, 95% confidence interval (CI): 5.9-11.7, P<0.0001), insurance coverage (no coverage vs coverage, OR 6.9, 95% CI: 5.2-9.1, P<0.0001) and race (African-American vs Caucasian, OR 2.4, 95% CI: 1.9-2.9, P<0.0001). Physician (perception of HCT risks), system (insurance coverage) and patient (age, social support and co-morbid illness) factors were strongly endorsed by respondents as important determinants of their HCT referral practices. These data speak to important factors relevant to HCT referral practices, and highlight several opportunities for education and intervention to reduce current disparities.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • African Americans
  • Age Factors
  • Comorbidity
  • European Continental Ancestry Group
  • Female
  • Health Care Surveys
  • Healthcare Disparities* / economics
  • Healthcare Disparities* / ethnology
  • Hematology
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Hematopoietic Stem Cell Transplantation* / economics
  • Hematopoietic Stem Cell Transplantation* / psychology
  • Humans
  • Insurance Coverage
  • Insurance, Health
  • Leukemia / economics
  • Leukemia / epidemiology
  • Leukemia / ethnology
  • Leukemia / therapy*
  • Male
  • Medical Oncology
  • Middle Aged
  • Myelodysplastic Syndromes / economics
  • Myelodysplastic Syndromes / ethnology
  • Myelodysplastic Syndromes / therapy*
  • Practice Patterns, Physicians'*
  • Referral and Consultation*
  • Social Support
  • Transplantation, Homologous
  • United States / epidemiology
  • Workforce