Positive Referrals Research Articles

Structure and Content: Interorganizational Referral Valence and Limited Partner Investment Decisions

Network theory has long assumed interorganizational relationships act as pipes transmitting information across the market, but have rarely considered the effect of the content of such information on organizations’ behavior. In particular, scholars have attributed the well documented phenomenon of triadic closure – the tendency of actors to form direct ties with those that they are indirectly connected to through shared partners – to the flow of referrals across the indirect ties, without considering whether such referrals are positive or negative. I argue that the effect of indirect ties will be contingent on the performance of the collaboration across the existing ties: success will increase the chance of positive referrals and triadic closure, but failure will lead to negative referrals and reduce the probability of closure. Furthermore, the reputation of the shared partner will magnify the effects of both positive and negative referrals. Finally, actors will reduce their reliance on referrals if they have access to other sources of public or private information about the prospective counterparties. I find support for these hypotheses with a longitudinal dataset of the investment decisions of Limited Partners (LP) investing in Venture Capital (VC) firms.

Recruiting Through Employee Referrals: An Examination of Employees’ Motives

As previous research focused on the outcomes of employee referrals, not much is known about its determinants. This study examined employees’ intrinsic, prosocial, and extrinsic motives for encouraging versus discouraging others to apply with their employer. In a sample of 232 employees from two organizations, job satisfaction, the desire to help job seekers find good fitting jobs, the desire to help the organization find good fitting employees, and rewards predicted positive referrals. Negative referrals were motivated by job dissatisfaction and the desire to help job seekers avoid bad fitting jobs. Moreover, in the organization rewarding employees for making referrals, more positive and less negative referrals were made than in the organization without referral program.

Purchasing Managers' Perceived Bias in Supplier‐Selected Referrals

In evaluating suppliers in complex purchasing decisions involving customized solutions, purchasing managers must judge the capabilities suppliers have to provide the solutions, a judgment that often includes considerable uncertainty. To reduce this uncertainty, suppliers often ask their existing customers to be reference customers and give a referral to purchasing managers — that is, suppliers and purchasing managers consider a supplier‐selected referral as a source of information. However, in contrast to other information sources, reference customers are selected by suppliers, not by purchasing managers; thus, purchasing managers may perceive a bias in the supplier‐selected referral. We study the antecedents of purchasing managers' perceived bias with a mixed‐design experiment with purchasing managers as respondents. We find that the greater the experience of purchasing managers, the less the bias in the referral they perceive. We also find that reference customers can reduce purchasing managers' perceived bias in the supplier‐selected referral by giving a referral that has some negative information in an otherwise positive referral.

Results of a community vision-screening program using the Spot photoscreener

To describe the results of vision screenings performed with the Spot photoscreener in the community setting. Low-income, predominantly Hispanic children in day care and preschool settings were screened by lay operators using the Spot photoscreener. Inclusion criteria were age 6-72 months and availability of a complete photoscreening record. Referral criteria were based on Vision Screening Committee of American Association for Pediatric Ophthalmology and Strabismus guidelines. Data were stratified by age group and analyzed for percentage of children referred for hyperopia, myopia, astigmatism, anisometropia, anisocoria, and ocular misalignment. Vision screening records were compared with comprehensive eye examination records from an optometrist or ophthalmologist to determine positive predictive value. Vision screening examinations were performed on 8,317 subjects from September 2011 through May 2012. The mean age of the 7,814 subjects (3953 males) meeting inclusion criteria was 44.4 months. The Spot referred 2,393 (30.6%). Of the screened population, the suspected reason for referral was astigmatism in 1,863 (23.8%), ocular misalignment in 879 (11.3%), anisometropia in 90 (1.2%), myopia in 82 (1.1%), hyperopia in 63 (0.8%), and anisocoria in 16 (0.2%). Comprehensive examination reports, including a cycloplegic refraction, were available for 300 referred children (12.5%). The reason for referral was confirmed in 55.7%, with an overall positive predictive value of 65.7%. The Spot photoscreener yielded a high overall referral rate. Although a high prevalence of astigmatism may be expected in this population, a high referral rate for suspected ocular misalignment led to a very high proportion of false positive referrals, suggesting that the software for this algorithm is in need of refinement.

The influence of brand trust and brand identification on brand evangelism

Purpose – The purpose of this study is to examine how the nature of consumers' relationship with a brand influences brand evangelism, which represents an intense form of brand support behavior. Specifically, the study investigates the influence of two consumer-brand relational constructs, brand trust and brand identification, on brand evangelism. Brand evangelism, conceptualized as an amalgam of adoption and advocacy behaviors, is operationalized in terms of three supportive behaviors: purchase intentions, positive referrals, and oppositional brand referrals. Design/methodology/approach – Drawing from prior research on consumer-brand relationships, a framework of brand relationships and brand evangelism is developed. To provide a more robust test of theory, consumers' extraversion, gender, and brand experience are included as control variables. Structural equation modeling is used to test the proposed hypotheses. Findings – The findings reveal that consumer-brand relationships influence brand evangelism, albeit in different ways. Whereas brand trust influences purchase intentions and positive referrals, brand identification influences positive and oppositional brand referrals. Overall, the findings reveal the power of consumer-brand relationships in engendering brand evangelism, relative to other factors such as extraversion, gender, and brand experience. Practical implications – In today's consumption society, where it is increasingly easier for consumers to demonstrate extreme devotion and derision toward brands, it is important for marketers to understand the drivers of behaviors directed toward brands. This study suggests that marketers can cultivate brand evangelism by building brand trust and brand identification. Originality/value – Marketing researchers and practitioners are only recently beginning to understand brand evangelism. This study demonstrates that consumer-brand relationships, rather than personality, gender, and usage experience, trigger brand evangelism and offers directions for future researchers to further explicate brand evangelism.

Referral types and peer activation: Who to ask?

This paper explores how consumers select different peers in their social network when obtaining positive verses negative referrals, and the role of social cues in this selection process. An inductive framework incorporating a mixed method process was employed. Thirty in-depth interviews were used to understand how consumers activate specific peers when seeking referrals. First, participants mapped their peer networks and, second, debriefs were undertaken to understand how their peer networks were used across ten product categories. Our research identifies that the choice of peer when seeking referral information is conditional on the type of referral sought. Also, that the cues used by consumers when selecting the most appropriate peer differ depending on the type of referral sought. The different peer activation for these two types of referrals indicates a need to adopt strategies specific to the different referral types.

Generating Business Referrals for SMEs: The Contingent Value of CEOs' Social Capital*

We examine how small and medium‐sized enterprise (SME) chief executive officers' (CEOs) social capital (as measured by strength of ties and structural holes) can help them bring business to their firms through the spread of positive referrals. Based on a sample of 408 French SME CEOs, we find a direct effect of social capital. Such effect is contingent on the CEO's personality, with social capital being most beneficial to CEOs with low levels of conscientiousness. CEOs' social ties facilitate the distortion of information, thereby leading personal contacts to give referrals to and endorse a focal CEO, even in the presence of negative signals, such as low conscientiousness.

Multimodal hyperspectroscopy as a triage test for cervical neoplasia: Pivotal clinical trial results

ObjectiveTo prospectively evaluate a new non invasive device that combines fluorescence and reflectance spectroscopy in a population in women at risk for cervical dysplasia. MethodsA total of 1607 women were evaluated with multimodal hyperspectroscopy (MHS), a painless test with extremely high spectral resolution. Subjects who were referred to colposcopy based on abnormal screening tests or other referral criteria underwent the MHS test and also had a sample taken for additional cytology and presence of high risk human papilloma virus (HPV) prior to undergoing biopsy. ResultsSensitivity of MHS for cervical intraepithelial neoplasia (CIN) 2+ was 91.3% (252/276). Specificity, or the potential reduction in referrals to colposcopy and biopsy, was 38.9% (222/570) for women with normal or benign histology and 30.3% (182/601) for women with CIN1 histology. Two year follow-up data, collected for a subgroup of 804 women, revealed 67 interval CIN2+ that originally were diagnosed at enrollment as normal or CIN1. MHS identified 60 of these (89.6%) as positive for CIN2+ prior to their discovery during the two year follow-up period. ConclusionsMHS provides an immediate result at the point of care. Recently, the limitations of cytology have become more obvious and as a consequence greater emphasis is being placed on HPV testing for cervical cancer screening, creating a need for an inexpensive, convenient and accurate test to reduce false positive referrals to colposcopy and increase the yield of CIN2+ at biopsy. MHS appears to have many of the attributes necessary for such an application.

There is a trend for the diagnosis of glaucoma to be made at an earlier stage in 2010 compared to 2008 in Oxford, United Kingdom

New guidelines on glaucoma diagnosis and management were published by the National Institute of Clinical Excellence (NICE) in 2009. The aim of this study was to determine whether these guidelines on glaucoma referral have changed the numbers of patients diagnosed with glaucoma in Oxford and whether the severity of disease at presentation has altered between 2008 and 2010. A retrospective study was undertaken of patients referred to a glaucoma case-finding clinic at the Oxford Eye Hospital in 2008 and 2010. Severity of glaucoma was assigned on the basis of the worse eye and defined according to mean deviation (MD) on 24-2 Humphrey visual field testing, with early glaucomatous visual field defects defined as MD less than -6 dB, moderate defects as MD between -6 and -12 dB and severe defects as MD more than -12 dB. Statistical analysis was undertaken using Chi squared and Mann Whitney tests. The number of referrals to this clinic increased from 521 patients in 2008, to 895 patients in 2010. 85 (16.3%) patients were diagnosed with ocular hypertension in 2008, compared to 144 (16.1%) in 2010. The number of patients diagnosed with glaucoma increased from 94 cases in 2008 to 113 cases in 2010, although the percentage of referrals diagnosed with glaucoma fell from 18.1% to 12.6%. More patients diagnosed with glaucoma in 2010 had early disease (61.9% in 2010 vs 48.8% in 2008, p = 0.03). Patients found to have glaucoma in 2010 had less severe visual field defects than in 2008: patients presented with a lower mean deviation (-6.36 dB in 2010, -7.95 dB in 2008, p = 0.03) and lower pattern standard deviation (5.44 dB in 2010, 6.64 dB in 2008, p = 0.02). However, there was no significant difference between age of presentation (65.1 years in 2010, 65.2 years in 2008, p = 0.82), and IOP (21.62 mmHg in 2010, 23.15 mmHg in 2008, p = 0.22). There has been a significant increase in number of referrals to the glaucoma case-finding clinic in Oxford between 2008 and 2010. The introduction of NICE referral guidelines in 2009 has had the benefit of increasing the absolute number of patients detected with glaucoma and has resulted in more patients being diagnosed with early disease. More effort needs to be made to reduce the number of false positive referrals. In addition, the guidelines on referral of individuals with ocular hypertension need to be reconsidered.

Trends in outpatient follow-up rates in England

Trends in the follow-up rate for a variety of outpatient specialties are investigated over a 24 year period. In the majority of specialties the greatest reduction in the follow-up rate occurred prior to 2000/01. Many specialties exhibit a degree of cyclic behaviour in the follow-up rate which seems to arise out of non-linear behaviour over time in the rates of GP referral. Sudden increases in GP referral can arise from a congruence of adverse environmental conditions; i.e. sporadic ‘spike’ events, or due to longer term cycles in the wider environment (including infectious outbreaks). Such increases result in a higher proportion of false positive GP referrals leading to a dip in the follow-up rate. GP commissioners in England are advised to pay far greater attention to the undulating nature of outpatient activity and costs. Potential environmental factors contributing to such cycles are discussed along with the implications to activity and cost forecasting.

High risk medicolegal autopsies: is a full postmortem examination necessary?

AimsAiming to reduce the numbers of high risk autopsies, we use a minimally invasive approach. HIV/hepatitis C virus (HCV)-positive coronial referrals, mainly intravenous drug abusers, have full autopsy only if...

Review of preschool vision screening referrals in South Auckland, New Zealand

Background: Limited data are available on the causes of visual impairment in preschool children in New Zealand. We aimed to review demographic and visual parameters in children referred to the Ophthalmology Department, Manukau Super Clinic from vision screening programs in South Auckland.Methods: Retrospective medical record review of 131 children, aged three to five years, referred from community‐based vision screening programs to the Ophthalmology Department for further assessment. Medical records were reviewed to determine: the reason for referral; findings from ophthalmic assessments; treatment received; and visual acuity at the final visit. The main outcome measures were the cause of visual impairment in children referred from preschool vision screening and the visual acuity at the final follow‐up visit.Results: Thirty‐eight (29.0 per cent) children were discharged after their initial assessment as false positive referrals. Almost half (45.5 per cent) of the children were prescribed glasses for the correction of refractive error, amblyopia or strabismus. Twenty‐nine (22.1 per cent) children were diagnosed with amblyopia with an average follow‐up period of 17.5 ± 2.7-months. In general, compliance with therapy for amblyopia was poor with 48.3 per cent non‐compliant with their prescribed treatment regimen. Despite this, visual outcomes were good with an average final visual acuity in the amblyopic eye of 0.294 ± 0.231-logMAR (Snellen 6/12).Conclusions: The ‘positive predictive value’ for the Counties‐Manukau preschool vision screening program was 47.4 per cent, suggesting that the visual acuity measurements alone produce a significant number of false positive results. In children diagnosed with amblyopia, early detection and intervention showed significant improvement in vision in the amblyopic eye, with many children also showing improved binocular function.

A model for managing glaucoma referrals in secondary care

This article describes a referral refinement model used in Sheffield to manage and streamline referrals received by the eye department. Serving a population of approximately 500 000 residents, the ophthalmic unit in Sheffield receives almost 800 referrals per year with suspected glaucoma. A significant number of these are false positive referrals that are subsequently discharged within a dedicated glaucoma unit. The article illustrates an established model that triages referrals, providing more capacity in clinic for those patients who do need to be seen and considered for treatment.

Sex doesn't matter: the role of gender in the formation of student-university relationships

As competition intensifies, higher education providers are facing ever more complex challenges in attracting and retaining students. These new marketing challenges have necessitated a need to more comprehensively understand the factors that lead to positive perceptions of the institutions services, as well as positive referral of the brand. This research focuses on students' perceptions of the importance of satisfaction, trust, and commitment in the development of student loyalty. In particular this research examines whether or not these antecedents differ for male versus female students. A structural equation modelling approach was adopted using a sample of 447 students. Despite literature which characterises males as task oriented, and females as relationship oriented, gender did not influence the salience of the antecedents to loyalty. These results show that first and foremost both gender groups seek to form affective and emotional bonds with their institution and hence a sense of psychological closeness to it. Student satisfaction was found to be the second most important driver of loyalty across both genders. Conclusions, implications and opportunities for future research are presented. From a managerial perspective, it is expected that uncovering the importance of key relationship marketing constructs between genders will enable higher education institutions to develop more targeted relationship marketing programs.

Improving Expanded Newborn Screening

We thank the editors of JHSB for the opportunity to respond to the commentary by Watson, Howell, and Rinaldo. The commentators are the authors of the 2006 ACMG report that paved the way for expanded newborn screening. We appreciate their attention to our research. Most of their comments, however, reflect the imposition of biomedical cri teria upon a sociological project. We realize that the considerable criticism from geneticists, bio ethicists, and public health researchers directed toward the ACMG report (see, for example, Botkin et al. 2006) created sensitivity about anything that can be construed as further devaluation of expanded newborn screening. We would like to clarify that we did not pass broad negative judg ment on expanded newborn screening. All of the parents whom we interviewed during our study viewed newborn screening in a positive light, despite the difficulties and uncertainties that it cre ated for their families. We, too, recognize that newborn screening has the potential to make a positive impact on children's health and well being. Our goal was to rigorously study the com munication of newborn screening results and the broader social impacts of a novel medical technol ogy. The social consequences we identified are not unique to newborn screening but are typical of many technological innovations in medicine and will only gain importance as genomic information becomes increasingly available. The challenges are not insurmountable but do require careful study and policy attention. We acknowledge that our claim that 90% of positive referrals result in false positives is now outdated. Nevertheless, we believe that several other criticisms are erroneous and result from mis

Spreading the Word of Fashion: Identifying Social Influencers in Fashion Marketing

Regarded as the most powerful force in the fashion marketplace, often more powerful and valuable than planned communication from marketing organizations, word-of-mouth (WOM) has been recognized in marketing research for many decades. Who are the main transmitters of WOM, and why are some of them more successful at diffusing new fashions and styles in social networks than others? How can social influencers be characterized? A comprehensive understanding and management of fashion-oriented referral behavior implies the in-depth analysis of its conditions and drivers, as well as the identification of those customers with the highest social influence potential and WOM value. The contribution of this paper is to give a theoretical and empirical overview of relevant factors characterizing social influencers in fashion marketing and their fashion-oriented referral behavior. In the course of the paper, ten different factors are described and empirically tested, characterizing three different clusters of social influencers: the fashion superspreaders, the narrative fashion experts and the helpful friends. A comprehensive understanding and better management of WOM referral behavior implies the in-depth analysis of its conditions and drivers as well as the identification of those customers with the highest social influence potential and value. According to Columbia voting studies, social influence is related to “who one is,” “what one knows” and “whom one knows”. “Who one is” and “what one knows” affect the individual capital that results from several demographic, psychographic, and personality variables. The importance of “whom one knows” was subdivided into the idea of accessibility — addressing an influencer’s central location in the networks in which he is embedded — and the idea that an “... individual may be influential not only because people within his group look to him for advice but also because of whom he knows outside his group”. Thus, for the purposes of this paper, the WOM behavior and referral style of customers is to be related to the customer’s individual and social capital attributes: A customer’s individual capital includes a customer’s personality, knowledge, skills and abilities. Relating to a profound understanding of WOM communications, a customer’s social capital requires the existence of and the effects resulting from specific and sustained social relationships between consumers. In terms of a customer’s reference value, social capital addresses his social resources and is related to the effects of WOM referral behavior, such as the customer’s opportunity, motivation, and ability to disseminate WOM, as well as the scope, contents, and influence of the referral flows. To analyze the relevancy of different variables measuring individual and social capital to portray high social influence potential in a more aggregated sense, the dimensions of individual and social capital needed to be operationalized. Preparing the empirical test of our model, we used already existing and tested measures and generated further items resulting from exploratory interviews resulting from exploratory interviews with marketing and fashion experts being asked what individual traits or social resources they associate with social influencers. The first version of our questionnaire was face validated twice using exploratory and expert interviews and pre-tested with 50 respondents to identify the most important and reduce the total number of items. The sample used in this study was defined as male or female German respondents, aged 18 years and older. A total of 480 interviews were conducted in the summer of 2007. Data were analyzed in three stages: First, the various dimensions underlying the individual and social capital of social influencers were uncovered by a factor analysis using the principal component method with varimax rotation. Then, the factor scores for each respondent were saved and consequently used in stage two for clustering them into different groups of social influencers. The results strongly suggested the presence of three clusters. Based on the variables from which they derived, the empirical findings give cause for labeling the three empirically verified clusters as follows: the fashion superspreaders the narrative fashion experts, and the helpful friends. Each type of social influencer is characterized by a different underlying philosophy of giving or not giving WOM referrals, which helps marketing managers to understand the nature and extent of WOM communications and might serve as a theoretical basis for efficiently generating and man-aging positive WOM referrals from existing clients. This knowledge can improve the efficiency of selecting different customer groups and of encouraging appropriate key consumers to leverage their WOM potential.

Health visitor referrals to secondary vision screening clinic: a 5-year review

Aim: To analyse referrals from health visitors to a (secondary) orthoptic Children’s Vision Screening Clinic (CVSC) over a 5-year period, to assess whether a change in the type of testing, increase in age at testing, and also training from an orthoptist, had influenced the accuracy of testing and referrals. Methods: Data were collected from a departmental database to include a time span from 2 years prior to the changes to 2 years after implementation of operational changes. The changes were: (i) assessment at age 4 years instead of 3 years, (ii) visual acuity (VA) testing with a linear test instead of single optotypes and (iii) health visitor training on VA assessment. The referral reason and outcome of the visit to the CVSC were documented. Results: The results show that, over the 5-year period studied, similar proportions of children were being referred each year with the three most common vision problems. The number of false-positive referrals fell following the operational changes made in 2004, i.e., the accuracy of referrals increased: accurate (positive) referrals of children referred with reduced vision in one eye improved from 18% to 81% and those of children referred with reduced vision in both eyes increased from 35% to 75%. These differences were statistically significant. Conclusion: Changing to a linear test at an increased age of 4 years, along with regular teaching and updates, has had a beneficial effect on the quality of the referrals to the CVSC. To comply fully with national screening guidelines, further changes are needed and the service continues to evolve.

Oral Cancer Screening: What Have We Learnt and What is There Still to Achieve?

Oral cancer is an important global healthcare problem. In the UK, the incidence is increasing and late-stage presentation is common. Determining the feasibility of a national screening program for oral cancer is therefore an important step in the prevention of the disease. Evidence exists to suggest that an oral examination of high-risk individuals may be a cost-effective screening strategy. However, questions remain over which primary care environment would be the most suitable and the criteria for a positive screen and referral. Further research is needed in the form of clinical trials or demonstration studies in primary care. The impact on secondary care, the role of auxiliaries and training needs also need to be determined. In addition, the assessment of adjunctive aids and evaluation of potential biomarkers are considered important.

Unsuspected coagulopathy rarely prevents IV thrombolysis in acute ischemic stroke

American Heart Association/American Stroke Association guidelines recommend initiating treatment with IV tissue plasminogen activator (tPA) in acute ischemic stroke patients without suspected coagulopathy prior to availability of clotting results; however, little or no data support this practice. We sought to identify how often blood clotting abnormalities were responsible for withholding IV tPA at our institution. We conducted a retrospective review of our prospectively acquired Get With the Guidelines Stroke database from January 2003 to April 2008. All patients underwent clinical evaluation by a neurologist, diagnostic neuroimaging, and laboratory testing on admission. We classified patients with absolute contraindications to IV tPA as ineligible, and those with warnings/relative contraindications or potentially treatable factors as potentially eligible. Of 2,335 considered for analysis, 470 (20.1%) patients presented to our emergency department (ED) within 3 hours. Among these, 147 (31.3%) received IV tPA in our ED, 102 (21.7%) had an absolute contraindication, and 221 (47%) had a reason to consider withholding tPA. Only 30/470 (6.4%) of potential thrombolysis patients were discovered to have international normalized ratio > or =1.7 or platelets < or =100,000/microL, and of these, 28 were suspected a priori due to known coagulopathy from medication or illness. Only 2/470 (0.4%) patients had an unsuspected coagulopathy that ultimately prevented thrombolysis. Based on the experience of a large thrombolysis referral center, stroke patients without suspected clotting abnormality can safely begin thrombolytic therapy before clotting results are available. These data support the current practice guidelines, and may reassure clinicians that the benefits of early administration greatly outweigh the risks due to an unsuspected bleeding diathesis.

Facilitators and Barriers to Improving Interprofessional Referral Relationships Between Primary Care Physicians and Chiropractors

Findings from recent studies suggest that there are poor interprofessional referral relationships between primary care physicians (MDs) and chiropractors (DCs) and this can lead to fragmentation of care. The objective of this study is to identify potential facilitators and barriers to developing positive interprofessional referrals relationships between MDs and DCs. We conducted 2 rounds of focus group interviews on a convenience sample of MDs and DCs. The focus groups were audiotaped, and transcripts were prepared for each focus group interaction. These data were analyzed through content analysis by 2 independent evaluators to determine the key themes and concepts provided by the focus groups. Both MDs and DCs suggested that good communication, openness to discussion by providers, and patient interest are key factors for developing positive interprofessional referral relationships and implementing interprofessional practice-based research networks. Barriers to interprofessional relationships include lack of good communication between the 2 provider types, bias toward alternative medicine, lack of knowledge or understanding of chiropractic care, geographic constraints, and economic considerations. This study identified several facilitators and barriers for developing positive referral relationships between primary care physicians and chiropractors. Future studies must focus on demonstrating the role of these factors on developing positive interprofessional relationships.