Longer-term impact of cardiology e-consults

Wasfy, Jason H.; Rao, Sandhya K.; Kalwani, Neil M; Chittle, Melissa D; Richardson, Calvin A.; Gallen, Kathleen M.; Isselbacher, Eric M.; Kimball, Alexa B.; Ferris, Timothy G.

doi:10.1016/j.ahj.2015.11.019

Cited by 48 publications

(39 citation statements)

References 11 publications

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“…More than half of the included studies were from 1 of 2 settings: 26 from the Champlain BASE program and 13 from VA settings. 7,[37][38][39][40][41][42][43][44][45][46][47][48] Of the remaining 24 studies, there were 12 from community health centers or large public health care systems, 43,[49][50][51][52][53][54][55][56][57][58][59] 8 from academic medical centers, [60][61][62][63][64][65][66][67] 2 from a nongovernmental humanitarian organization, 68, 69 1 from a not-for-profit integrated health care delivery system, 70 and 1 from a private company providing e-consult services. 71 Most studies were observational in design and lacked a control group.…”

Section: Methodsmentioning

confidence: 99%

“…71 Most studies were observational in design and lacked a control group. One study reported data from a pilot randomized controlled trial; 53 3 studies reported results from cluster randomized controlled trials; 49,56,70 3 studies were pre-post evaluations with a comparison group; 62,66,72 and 1 study employed a retrospective cohort design with a comparison group. 48 Most results were positive.…”

Section: Methodsmentioning

confidence: 99%

“…Two studies compared the change in face-to-face referral rates pre-and post-implementation between specialties with and without e-consultation. 62,66 One year after implementation of a cardiology e-consult program in an academic medical center, the increase in face-to-face cardiology referrals was less than that for specialties without e-consultation (4.5% vs 10.1%, P < .001). 66 E-consults in an academic medical center were associated with a decrease of 19% in face-toface referrals, compared to an increase of 3.6% among nonparticipating specialties.…”

Section: Costsmentioning

confidence: 99%

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Electronic consultations (E-consults) and their outcomes: a systematic review

Vimalananda

Orlander

Afable

et al. 2019

Journal of the American Medical Informatics Association

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Objective Electronic consultations (e-consults) are clinician-to-clinician communications that may obviate face-to-face specialist visits. E-consult programs have spread within the US and internationally despite limited data on outcomes. We conducted a systematic review of the recent peer-reviewed literature on the effect of e-consults on access, cost, quality, and patient and clinician experience and identified the gaps in existing research on these outcomes. Materials and Methods We searched 4 databases for empirical studies published between 1/1/2015 and 2/28/2019 that reported on one or more outcomes of interest. Two investigators reviewed titles and abstracts. One investigator abstracted information from each relevant article, and another confirmed the abstraction. We applied the GRADE criteria for the strength of evidence for each outcome. Results We found only modest empirical evidence for effectiveness of e-consults on important outcomes. Most studies are observational and within a single health care system, and comprehensive assessments are lacking. For those outcomes that have been reported, findings are generally positive, with mixed results for clinician experience. These findings reassure but also raise concern for publication bias. Conclusion Despite stakeholder enthusiasm and encouraging results in the literature to date, more rigorous study designs applied across all outcomes are needed. Policy makers need to know what benefits may be expected in what contexts, so they can define appropriate measures of success and determine how to achieve them.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Costsmentioning

confidence: 99%

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Electronic consultations (E-consults) and their outcomes: a systematic review

Vimalananda

Orlander

Afable

et al. 2019

Journal of the American Medical Informatics Association

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“…Patients who were referred to hepatology in our study through eConsult received specific and relevant feedback from a hepatologist in an average of 22 hours compared with a wait time of 68 days to be seen for an in‐person visit. A survey of PCPs at the University of Virginia Health System, who referred patients for eConsult, indicated that 91% were highly satisfied with the eConsult response; patients who were referred quoted the “practicality and ease of eConsults” as their primary benefit . Perhaps even more compelling is that patients who had never been referred for eConsult indicated a preference for future eConsults compared with traditional outpatient referrals …”

Section: Discussionmentioning

confidence: 99%

Electronic Consultations to Hepatologists Reduce Wait Time for Visits, Improve Communication, and Result in Cost Savings

et al. 2019

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“…Electronic consults and related training mechanisms allow PCPs to obtain specialist advice regarding diagnosis and treatment without making a formal referral. Electronic consults have been shown to be acceptable to PCPs and specialists, although patients require ongoing management by the PCP rather than transferring care to a specialist . Electronic consults can increase PCP skill sets and comprehensiveness of their care, but may be difficult to sustain if PCPs are not adequately compensated for the additional workload .…”

Section: Discussionmentioning

confidence: 99%

Differences in referral patterns for rural primary care physicians from 2005 to 2016

Geissler

2019

Health Services Research

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| INTRODUC TI ONReferrals from primary care physicians (PCP) to specialists and among different specialists and subspecialists are important contributors to medical care costs and quality. 1,2 Referrals have increased over time, potentially due to the increased complexity of medical care 1 ;research shows PCP referral rates are stable within physician over time, but have significant variation across physicians. 4-6 Referrals contribute to appropriate medical care 1,4 ; better understanding current determinants of referrals and appropriate use is important for improving care delivery, particularly in medically underserved rural areas. 7,8 Access to care and availability of specialists are concerns in rural areas due to distance to providers and the nonrural location of many specialists. 7-10 This results in decreased specialist visits and an increased reliance on PCPs in rural areas. 11The ideal PCP referral rate within and across conditions to optimize patient care to provide the highest quality at the lowest cost is unknown. Referrals may be both over-and under-used by PCPs 12 ; referrals may generate excess spending and increase care fragmentation, but specialists have been shown to be more likely to Abstract Objective: To examine differences in referral patterns in a nationally representative sample between primary care physicians (PCP) practicing in rural vs nonrural areas and changes over time. Study Design: Using the 2005-2016 National Ambulatory Medical Care Survey and multivariate logit regression models, I compare referral patterns of PCPs in rural vs nonrural areas. Data Collection: Multiple years of data were combined.Principal Findings: A PCP visit was 1.9 percentage points (95% confidence interval: 0.1 pp, 3.8 pp) more likely to result in a referral in nonrural areas than rural areas, controlling for physician and patient characteristics, a 17 percent increase. This difference is driven by a widening gap in referral rates between nonrural and rural areas over time, with large differences in later periods. The regression-adjusted predicted probability of a PCP visit resulting in a referral was 71 percent higher in nonrural than rural areas in 2013-2014 and 92 percent higher in 2015-2016. Conclusions:Recognizing that the optimal PCP referral rate is unknown, referrals are less common in rural areas with a widening gap in recent years. This difference may reflect specialist availability, distance to care, or patient preferences. As changes occur to health care financing and delivery, continuing to monitor practice patterns is important to ensure patients are receiving appropriate levels of care across geographic regions. K E Y W O R D S ambulatory care, physician practice patterns, referrals, rural S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Geissler KH. Differences in referral patterns for rural primary care physicians from 2005 to 2016.Health Serv Res. 2020;55:94-102. https ://doi.

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Longer-term impact of cardiology e-consults

Cited by 48 publications

References 11 publications

Electronic consultations (E-consults) and their outcomes: a systematic review

Electronic consultations (E-consults) and their outcomes: a systematic review

Electronic Consultations to Hepatologists Reduce Wait Time for Visits, Improve Communication, and Result in Cost Savings

Differences in referral patterns for rural primary care physicians from 2005 to 2016

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