Building a Medical Neighborhood in the Safety Net: An Innovative Technology Improves Hematuria Workups

Bergman, Jonathan; Neuhausen, Katherine; Chamie, Karim; Scales, Charles D.; Carter, Stacy M; Kwan, Lorna; Lerman, Stephen; Aronson, William J.; Litwin, Mark S.

doi:10.1016/j.urology.2013.08.015

Cited by 20 publications

(14 citation statements)

References 19 publications

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“…Four of the 9 described e-consults for multiple specialties at Kaiser Permanente Colorado (a large group model integrated health system), 8 from a regional network in Canada, 26 , 27 and from a region of Finland. 28 The other five of 9 described e-consult use for a single specialty in regional networks in north England, 29 Ireland, 30 and the Netherlands, 31 and from single clinical departments within Olive View-UCLA Medical Center 32 and Massachusetts General Hospital (MGH). 33 Of the 22 research studies, study designs were retrospective (8), cross-sectional (4), pre-post (4), prospective (2), case-control (2), qualitative (1), and simulation (1).…”

Section: Resultsmentioning

confidence: 99%

Electronic consultations (e-consults) to improve access to specialty care: A systematic review and narrative synthesis

et al. 2015

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BackgroundWe define electronic consultations (“e-consults”) as asynchronous, consultative, provider-to-provider communications within a shared electronic health record (EHR) or web-based platform. E-consults are intended to improve access to specialty expertise for patients and providers without the need for a face-to-face visit. Our goal was to systematically review and summarize the literature describing the use and effects of e-consults.MethodsWe searched PubMed, EMBASE, the Cochrane Library, and CINAHL for studies related to e-consults published between 1990 through December 2014. Three reviewers identified empirical studies and system descriptions, including articles on systems that used a shared EHR or web-based platform, connected providers in the same health system, were used for two-way provider communication, and were text-based.ResultsOur final review included 27 articles. Twenty-two were research studies and five were system descriptions. Eighteen originated from one of three sites with well-developed e-consult programs. Most studies reported on workflow impact, timeliness of specialty input, and/or provider perceptions of e-consults. E-consultations are used in a variety of ways within and across medical centers. They provide timely access to specialty care and are well-received by primary care providers.DiscussionE-consults are feasible in a variety of settings, flexible in their application, and facilitate timely specialty advice. More extensive and rigorous studies are needed to inform the e-consult process and describe its effect on access to specialty visits, cost and clinical outcomes.

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Section: Resultsmentioning

confidence: 99%

Electronic consultations (e-consults) to improve access to specialty care: A systematic review and narrative synthesis

et al. 2015

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“…Prompt diagnosis and treatment are critical to preventing progression of disease and improving patient survival [2][3][4]. Despite this, many patients experience significant delays in diagnosis [5]. Recent research has shown that among patients who present with symptoms suggestive of bladder cancer, 18% required three or more visits before a diagnosis was made [6], and women are particularly likely to experience delays in care resulting in late stage at diagnosis [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Application of Electronic Algorithms to Improve Diagnostic Evaluation for Bladder Cancer

Murphy¹,

Meyer²,

Vaghani³

et al. 2017

Appl Clin Inform

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“…Studies of eConsult systems have found decreased evaluation time for workup of medical conditions (i.e., hematuria), improved PCP access to specialty expertise from timely eConsult responses, and shorter wait times for in-person specialty care appointments, while maintaining high PCP, specialist and patient satisfaction [3–10]. There is limited literature on the impact of eConsult systems upon the efficiency of specialty care delivery.…”

Section: Introductionmentioning

confidence: 99%

“…Measuring the impact of eConsult systems on surgical yield, along with its determinants, may provide additional data to encourage their adoption by public healthcare delivery systems that traditionally have had poor surgical access [3, 12, 13], suboptimal inter-provider communication and care coordination, inappropriate referrals [14, 15], and high wait times for ambulatory clinic visits [16, 17]. The consequences of poor access to ambulatory specialty services within public health care systems, in particular surgical, include increased risk of requiring urgent or emergent surgery, longer lengths of hospitalizations, and decreased likelihood of receiving follow-up care [18–20].…”

Section: Introductionmentioning

confidence: 99%

A cohort study of a general surgery electronic consultation system: safety implications and impact on surgical yield

Ulloa

Russell

Chen

et al. 2017

BMC Health Serv Res

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BackgroundElectronic consultation (eConsult) systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers, while maintaining high primary care provider (PCP), specialist and patient satisfaction. Little is known about their impact on the efficiency of specialty care delivery, in particular surgical yield (percent of ambulatory visits resulting in a scheduled surgical case).MethodsRetrospective cohort of a random selection of 150 electronic consults from PCPs to a safety-net general surgery clinic for the three most common general surgery procedures (herniorrhaphy, cholecystectomy, anorectal procedures) in 2014. Electronic consultation requests were reviewed for the presence/absence of consult domains: symptom acuity/severity, diagnostic evaluation, concurrent medical conditions, and attempted diagnosis. Logic regression was used to examine the association between completeness of consult requests and scheduling an ambulatory clinic visit. Surgical yield was also calculated, as was the percentage of patients requiring unanticipated healthcare visits.ResultsIn 2014, 1743 electronic consultations were submitted to general surgery. Among the 150 abstracted, the presence of consult domains ranged from 49% to 99%. Consult completeness was not associated with greater likelihood of scheduling an ambulatory visit. Seventy-six percent of consult requests (114/150) were scheduled for a clinic appointment and surgical yield was 46%; without an eConsult system, surgical yield would have been 35% (p=0.07). Among patients not scheduled for a clinic visit (n=36), 4 had related unanticipated emergency department visits.ConclusionEconsult systems can be used to safely optimize the surgical yield of a safety-net general surgery service.

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Building a Medical Neighborhood in the Safety Net: An Innovative Technology Improves Hematuria Workups

Cited by 20 publications

References 19 publications

Electronic consultations (e-consults) to improve access to specialty care: A systematic review and narrative synthesis

Electronic consultations (e-consults) to improve access to specialty care: A systematic review and narrative synthesis

Application of Electronic Algorithms to Improve Diagnostic Evaluation for Bladder Cancer

A cohort study of a general surgery electronic consultation system: safety implications and impact on surgical yield

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