Referral bias may affect a patient’s diagnosis and management. Referral of a patient is not a random process but based on whether or not the referring clinician thinks that the referral is “justified.”
Parameter
More Likely To Be Referred
Less Likely To Be Referred
screening test
positive
negative
disease severity
moderate or severe
subclinical or mild
short life expectancy irregardless of management
no
yes
response to therapy
good
poor or less than expected
hazard associated with referral
low
high
Referral bias tends to increase the sensitivity and decrease the specificity of a test. The impact may be less if there is risk or severity adjustment.
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