A Study of the Implementation of an Electronic Consultation ("eConsult") Platform
- Conditions
- Cardiovascular Diseases
- Interventions
- Other: eConsult
- Registration Number
- NCT02376855
- Lead Sponsor
- Community Health Center, Inc.
- 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.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 36
- Primary Care Provider at Community Health Center, Inc who work at least 30 hours per week and see adult patients
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description eConsult eConsult The intervention consisted of an eConsult pathway and standardized protocol for PCPs to obtain cardiology consults using a secure messaging "peer to peer" (P2P) module embedded within the EHR. Intervention providers were asked to send all cardiology referrals for their adult patients through the eConsult system. Providers could bypass the eConsult pathway for patients with established relationships with a cardiologist or for whom providers felt a consult was urgent (required a face-to-face visit within a week or less). eConsults contain reason for consult, relevant test results, records or reports but are sent electronically to a Cardiology Consultant for review. eConsults were responded to within two business days. Responses were case-specific and generally contained recommendations for management, additional testing, or a face-to-face cardiology visit. The PCP was responsible for considering/acting upon recommendations and determining when an eConsult was complete.
- Primary Outcome Measures
Name Time Method 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 Outcome Measures
Name Time Method Total Cost Per Patient 6 months pre and 6 months post intervention Clinical costs per patient in control and intervention group from claims data
Completion of referrals 18 months The percent of referrals in each group that reached completion
Adverse events 18 months Adverse cardiology events, including MI, following cardiology eConsult or referral
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.
Hospital and Emergency Department Utilization 18 months Use of the hospital or Emergency Department for a cardiology complaint following an eConsult or referral
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
Trial Locations
- Locations (1)
Community Health Center, Inc
🇺🇸Middletown, Connecticut, United States