Cardiovascular Diseases
Conditions
Keywords
Health Services Accessibility
Brief summary
The purpose of this study is to evaluate the implementation of an electronic consultation model for specialty services (eConsults) to improve quality of care and reduce health system costs. An eConsult is a non-face-to-face consultation between a primary care provider and a specialist that takes place via secure messaging.
Detailed description
The study is a randomized, controlled trial where the intervention is the evidence-based eConsult model in which consults are submitted by electronic, secure messaging to a specialist for review and virtual consultation. Primary Care Providers will be randomized to the control or intervention group. In the intervention group, ALL new, non urgent, adult cardiology referrals will be submitted to the eConsult Cardiology team for an eConsult. Consults for children (age \<18) and consults for patients who already have an established relationship with another cardiologist will not be eligible for an eConsult. Urgent consults, such as those for patients with active chest pain or other acute conditions, will not be submitted for eConsult and should instead be handled by the on-site care team as per the standard protocol. For eConsults, the consult will be submitted using the eConsult pathway within the electronic health record. eConsults will be created in the same way that standard referrals are created, with attachment of a treatment summary, EKG, relevant results, and specification of the consultative question. The eConsult will be received by the intervention Cardiology team and reviewed within 2 business days. One cardiologist per day will be assigned to review and respond to eConsults. The result will be received by the primary care provider who will be responsible for acting appropriately on the cardiologist's recommendations. Recommendations will be case specific and may include one of three broad areas of suggestion: 1) suggestions for ongoing management by the primary care provider, 2) suggestions for additional testing in advance of a cardiology face to face appointment or to better determine a next course of action, and 3) immediate cardiology referral. For each of these options, the primary care provider will be responsible for following up and implementing the recommendations made by the Cardiologist. When referral is recommended the primary care provider will refer the patient to the cardiologist of their choice based on their location and the patient's preference. While not required, they may refer the patient to the eConsult cardiology team at University of Connecticut for face to face care if desirable, but may also refer to other Cardiologists. The intervention will last one year. Providers randomized to the control group will provide standard care which involves a traditional referral for an in-person cardiology visit.
Interventions
OTHEReConsult
An electronic consultation or eConsult is a secure message consult that allows specialists to provide advice on cases without seeing a patient face to face. They contain a reason for consult, any relevant tests, procedures or reports. The responsibility lies with the primary care provider to act, or not act on the advice as they deem fit.
Sponsors
Connecticut Health Foundation
University of Connecticut
UConn Health
Community Health Center, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Primary Care Provider at Community Health Center, Inc who work at least 30 hours per week and see adult patients
Exclusion criteria
\-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to first contact with a cardiologist | 18 months | For eConsults, time to first contact is the time between the generation of the eConsults and when the Cardiologist replies to the eConsults. For traditional referrals, first contact is the time between the creation of the appointment and the in-person Cardiology visi. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Adverse events | 18 months | Adverse cardiology events, including MI, following cardiology eConsult or referral |
| Hospital and Emergency Department Utilization | 18 months | Use of the hospital or Emergency Department for a cardiology complaint following an eConsult or referral |
| Completion of referrals | 18 months | The percent of referrals in each group that reached completion |
| Number of in-person cardiology visits | 18 months | The number of traditional, control referrals and eConsults that resulted in an in-person consultation with a cardiologist. |
| Total Cost Per Patient | 6 months pre and 6 months post intervention | Clinical costs per patient in control and intervention group from claims data |
| Provider Satisfaction (survey) | Baseline, 6 months, 12 months | A survey was administered to participants to measure their satisfaction with eConsults and/or the current referral process |
Countries
United States
Outcome results
None listed