In the article by Vollmer et al,1 the authors conclude that "specialist care of asthma is of benefit for patients with asthma in a large HMO." The authors allude to systems issues that may be important, but their "current study design is unable to sort out these potential confounding effects."
As a generalist, I have found that referring a patient to a specialist often offers the patient access to systems that have been developed from more frequent exposure to patients with similar problems. These systems include staff with expertise in the specialty problem, chart enhancements that facilitate data collection and documentation, educational aides, and availability of specific diagnostic and therapeutic equipment.
Ault MJ. Subspecialty Systems for Primary Care Providers: A New Alliance. Arch Intern Med. 1998;158(5):542. doi: