Association of eConsult Implementation With Access to Specialist Care in a Large Urban Safety-Net System

Abstract

IMPORTANCE Accessing specialty care continues to be a persistent problem for patients who use safety-net health systems. To address this access barrier, hospital systems have begun to implement electronic referral systems using eConsults, which allow clinicians to submit referral requests to specialty clinics electronically and enable specialty reviewers to resolve referrals, if appropriate, through electronic dialogue without an in-person visit.OBJECTIVE Measure the effect of implementing an eConsult program on access to specialty care. DESIGN, SETTING, AND PARTICIPANTSUsing an interrupted time series design with data from 2016 to 2020, this study analyzed 50 260 referral requests submitted during the year before and the year after eConsult implementation at 19 New York City Health + Hospitals (NYC H+H) specialty clinics that spanned 7 NYC H+H hospital facilities and 6 unique specialties.EXPOSURES Referral request was submitted to a specialty clinic in the year following eConsult implementation. MAIN OUTCOMES AND MEASURES Main outcomes included the fraction of referral requestsresolved without an in-person visit following eConsult implementation; and, among requests triaged to have an in-person visit, the fraction of referrals with a successfully scheduled appointment, mean wait time to a specialty appointment, and the fraction of referral requests with a completed specialty visit. Changes associated with eConsult implementation were estimated using multivariate linear regression adjusting for patient age, gender, and specialty clinic fixed effects. RESULTSAcross 19 NYC H+H specialty clinics, 26 731 referral requests were submitted in the year before and 23 529 referrals were submitted in the year after eConsult implementation. Following eConsult implementation, 13% of all requests were resolved electronically. Among requests requiring a follow-up visit, the fraction with an appointment successfully scheduled increased by 15.8%, from 66.5% to 82.3% (P < .001). The mean time to an appointment decreased from 61.0 days pre-eConsult to 54.1 days post-eConsult, an adjusted 8.2-day shorter wait time (or 13.3% reduction) following eConsult adoption (P < .001). The percentage of referrals with a completed follow-up visit with a specialist within 90 days of the request did not change (38.4% vs 37.9%, P = .07). Changes in outcomes were mitigated during months when most clinics underwent an electronic health record transition after implementing eConsult. CONCLUSIONS AND RELEVANCEIn this quality improvement study, implementation of eConsults at a large multi-specialty safety-net system was associated with improvements in appointment scheduling rates and wait times. Despite an additional electronic health record transition, eConsults are a promising health care delivery tool for increasing access to specialty care.

Provider supply and access to primary care

“…For example, many federally qualified health centers (such as county or regional health systems) are paid by capitation and are often supply constrained. Studies have shown that county and city health systems, which predominantly serve Medicaid patients, can suffer from long wait times (Barnett et al., 2017; Gaye et al., 2021).…”

“…Access issues are exacerbated in supply‐constrained systems, such as public healthcare delivery systems. For example, many Medicaid programs and federally qualified health centers have implemented policies to address these concerns (Barnett et al., 2017; Gaye et al., 2021; Rosenbaum et al., 2018).…”

Anatomic pathology quality assurance: Developing an LIS based tracking and documentation module for intradepartmental consultations

“…Electronic consultation has become more widespread in recent years, extending the benefits of the consultation process. 1 , 2 , 3 Consultation in anatomic pathology is an important component of the quality assurance functions in a laboratory and can prevent misdiagnosis. Prior studies in our department, as well as in many others, have shown significant numbers of major diagnostic discrepancies on re-review of pathology reports from other institutions’ pathology departments.…”

“…In the clinical setting, the availability of such consultation has decreased patient waiting times for specialist consultation and has had a particularly positive effect in patient populations that are underserved. 1 , 2 Surgical specialties have noted increased efficiency in scheduling surgical intervention in their waiting lists when utilizing e-consultation. 3 …”

Evaluation of BASE eConsult Manitoba: patient perspectives on the use of electronic consultation to improve access to specialty advice in Manitoba

“…The BASE eConsult model has been spread and scaled up in several other Canadian jurisdictions [ 7 ] and has demonstrated effectiveness in reducing wait times, achieving high levels of patient and provider satisfaction, and lowering costs of care [ 8 – 11 ]. A review of similar international eConsultation models has shown similar benefits [ 12 – 14 ].…”