CU Anschutz Rheumatologists Expand Access to Care Through eConsults and Off-Campus Clinics
核心洞察
CU Anschutz rheumatologists Liudmila Kastsianok, MD, and Steven Taylor, MD, have expanded rheumatology services to off-campus UCHealth clinics in Lone Tree and Cherry Creek to reach underserved patients.
The team is developing inpatient and outpatient eConsults that let rheumatologists advise referring primary care providers without a face-to-face visit, cutting response time to under 48 hours versus a roughly 30-day average wait.
The UCHealth Rheumatology Clinic's access metric grew by 9.4% year over year, and median lag time to see a rheumatologist decreased by 19 days.
Two rheumatologists in the University of Colorado Anschutz (搜索) Department of Medicine have spent the past year developing creative strategies to help more patients with autoimmune and inflammatory conditions access care, as a shortage of specialists and rising costs increasingly prevent Americans from receiving even basic medical treatment.
Associate Professor Liudmila Kastsianok, MD, and Assistant Professor Steven Taylor, MD, have collaborated on hiring new rheumatologists, increasing clinical availability at off-campus locations, and rolling out digital-enabled services such as inpatient and outpatient eConsults that can help doctors reach more patients.
"Access to medical care is an issue all over the U.S., and it's not going to get better over time," says Kastsianok. "How can we as doctors work creatively together to ensure that the needs of patients are met?"
A worsening access crisis in rheumatology
The demand for rheumatologic care is outpacing the supply of specialists. Recent polling suggests that in the past year alone, more than one-third (36%) of U.S. adults have skipped or delayed getting needed care because of costs. Meanwhile, autoimmune disease (搜索) diagnoses are increasing by roughly three to 12% per year, and relatively few medical students are choosing to become rheumatologists, with many existing doctors in the field approaching retirement age.
"There is an imbalance between patients needing to be seen and not enough rheumatologists to accommodate the demand," says Kastsianok.
Taylor emphasizes the stakes of this imbalance, noting that rheumatologic diseases can be devastating, impacting multiple body systems and potentially touching every area of a patient's life. "In recent years, we have made tremendous strides in discovering and translating remarkable therapies that truly change lives, but that only helps the patients who can be seen," he says.
Expanding the footprint to off-campus clinics
Kastsianok and Taylor have worked together at the UCHealth Rheumatology Clinic at CU Anschutz since early 2024 — Kastsianok as a medical director for rheumatology and Taylor as a community practice director. Facing limited space at their main clinic, the two sought to expand services elsewhere.
"We worked really hard to expand the footprint of rheumatology to off-campus UCHealth clinics," Kastsianok says. "So, we tried to find space in other clinics to hire rheumatologists."
The team expanded rheumatology services at the University of Colorado Hospital satellite clinic in Lone Tree and a UCHealth clinic in Cherry Creek. The Lone Tree location, which previously offered very limited rheumatology services, now has the equivalent of one full-time rheumatologist on-staff to serve patients in southern Colorado, an area where rheumatologists are scarce. The Cherry Creek clinic offers centralized access to patients across the Denver metro area.
Taylor, who was born in rural Colorado, underscores the importance of reaching underserved regions. "Rural communities often have profound issues with access to care. Many times patients have to drive five to six hours just to see a specialist," he says. "If we can work on creative applications of existing technologies to serve the residents of Colorado better, I'm all ears."
eConsults bring specialist expertise without a face-to-face visit
Beyond hiring more doctors in key locations, Kastsianok and Taylor have explored ways to provide rheumatology care that go beyond traditional in-person visits or even telehealth appointments. For patients who are not acutely ill and may not need to see a rheumatologist immediately, the team is developing a novel application of eConsults that allows rheumatologists to connect with referring primary care providers and offer specialized expertise without seeing a patient face-to-face.
CU Anschutz's eConsult program has been active since 2018 and is run by The Care Collaborative in partnership with the AAMC Project CORE. Taylor serves as the eConsult clinical informaticist and specialty transformation lead for The Care Collaborative.
After asking some questions, Kastsianok says, "We can provide some advice or guidance to the referring provider on what to watch for, what to do, what lab tests or imaging to order, to further evaluate the patient." Based on the consultation, doctors can triage each patient and decide whether they need more specialized care or whether they can remain in their patient-centered medical home, keeping care local and with clinicians the patients know and trust.
These consultations could allow many more patients to receive specialized rheumatological advice without the hassle of an appointment. Currently, the average wait time for a rheumatology appointment is around 30 days, but the time to receive an answer via an eConsult is less than 48 hours.
Inpatient eConsults reduce hospital transfers
Kastsianok and Taylor are also involved in a pilot effort to give inpatient eConsults to patients at UCHealth partner hospitals. While some patients may need to transfer to another facility for specialized rheumatologic care, others could use the new eConsult process to receive advice from a specialist without needing to transfer. This work, led by the Virtual Health Center at UCHealth, could reduce the need for patients to transfer hospitals and help provide rheumatology care to underserved areas of the state.
Today, only three hospitals in Colorado — the UCHealth University of Colorado Hospital, the Denver Health Medical Center and Hospital, and the Rocky Mountain Regional VA Medical Center — offer inpatient rheumatology care. Many of these inpatient eConsults are done for patients in Pueblo or Colorado Springs, where transferring to a Denver area hospital would potentially mean being hours away from home.
Reducing unnecessary hospital transfers can also be safer for many patients, minimizing the potential for disruptions and delays to care and avoiding the complications of transferring medical records and transitioning to a new care team.
Early signs of improved access
Because the inpatient and expanded outpatient eConsult programs are so new, it is too soon to definitively quantify their impact. However, there are already promising signs that doctors at the UCHealth Rheumatology Clinic are reaching more patients. The clinic's access metric — the number of appointments scheduled within 14 days — has grown by 9.4% compared to last year, and the median lag time between scheduling an appointment and seeing a rheumatologist has decreased by 19 days.
Going forward, Taylor says he wants to continue building on these successes and examining patient access from a systemwide perspective. Both physicians express pride in the work already done to broaden the reach of rheumatology care across Colorado.
"It's truly rewarding to find a challenge, face it, and work with other teams to solve this access issue," Kastsianok says. "We have to be as creative as possible with limited resources to ensure that patients get access to care and can at least get some kind of guidance from a specialist."