- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02376855
A Study of the Implementation of an Electronic Consultation ("eConsult") Platform
A Study of the Implementation of an Electronic Consultation ("eConsult") Platform to Increase Specialist Access for Patients in Underserved Populations: Impact on Provider Experience, Wait Times and Cost
Study Overview
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.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Connecticut
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Middletown, Connecticut, United States, 06457
- Community Health Center, Inc
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Primary Care Provider at Community Health Center, Inc who work at least 30 hours per week and see adult patients
Exclusion Criteria:
-
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Control
Providers in the Control group followed standard care protocols.
If they deemed a patient was in need of cardiology consultation, a referral was created using the standard process.
The referral was processed by a referral coordinator and transmitted to an appropriate cardiologist.
An appointment was then scheduled for the patient to have an in-person consultation with a cardiologist.
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Experimental: 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.
|
An electronic consultation or "eConsult" is a secure message consult that allows specialists to provide advice on cases without seeing a patient face to face.
They contain a reason for consult, any relevant tests, procedures or reports.
The responsibility lies with the primary care provider to act, or not act on the advice as they deem fit.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to first contact with a cardiologist
Time Frame: 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.
|
18 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Completion of referrals
Time Frame: 18 months
|
The percent of referrals in each group that reached completion
|
18 months
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Adverse events
Time Frame: 18 months
|
Adverse cardiology events, including MI, following cardiology eConsult or referral
|
18 months
|
Hospital and Emergency Department Utilization
Time Frame: 18 months
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Use of the hospital or Emergency Department for a cardiology complaint following an eConsult or referral
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18 months
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Provider Satisfaction (survey)
Time Frame: Baseline, 6 months, 12 months
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A survey was administered to participants to measure their satisfaction with eConsults and/or the current referral process
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Baseline, 6 months, 12 months
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Number of in-person cardiology visits
Time Frame: 18 months
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The number of traditional, control referrals and eConsults that resulted in an in-person consultation with a cardiologist.
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18 months
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Total Cost Per Patient
Time Frame: 6 months pre and 6 months post intervention
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Clinical costs per patient in control and intervention group from claims data
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6 months pre and 6 months post intervention
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: J. Nwando Olayiwola, MD, MPH, Center for Excellence in Primary Care, University of California, San Francisco
- Principal Investigator: Daren Anderson, MD, Weitzman Institute, Community Health Center, Inc
Publications and helpful links
General Publications
- Chen AH, Yee HF Jr. Improving primary care-specialty care communication: lessons from San Francisco's safety net: comment on "Referral and consultation communication between primary care and specialist physicians". Arch Intern Med. 2011 Jan 10;171(1):65-7. doi: 10.1001/archinternmed.2010.484. No abstract available.
- Yee HF Jr. The patient-centered medical home neighbor: A subspecialty physician's view. Ann Intern Med. 2011 Jan 4;154(1):63-4. doi: 10.7326/0003-4819-154-1-201101040-00011.
- Chen AH, Kushel MB, Grumbach K, Yee HF Jr. Practice profile. A safety-net system gains efficiencies through 'eReferrals' to specialists. Health Aff (Millwood). 2010 May;29(5):969-71. doi: 10.1377/hlthaff.2010.0027. No abstract available.
- Foy R, Hempel S, Rubenstein L, Suttorp M, Seelig M, Shanman R, Shekelle PG. Meta-analysis: effect of interactive communication between collaborating primary care physicians and specialists. Ann Intern Med. 2010 Feb 16;152(4):247-58. doi: 10.7326/0003-4819-152-4-201002160-00010.
- Kim Y, Chen AH, Keith E, Yee HF Jr, Kushel MB. Not perfect, but better: primary care providers' experiences with electronic referrals in a safety net health system. J Gen Intern Med. 2009 May;24(5):614-9. doi: 10.1007/s11606-009-0955-3. Epub 2009 Mar 24.
- Kim-Hwang JE, Chen AH, Bell DS, Guzman D, Yee HF Jr, Kushel MB. Evaluating electronic referrals for specialty care at a public hospital. J Gen Intern Med. 2010 Oct;25(10):1123-8. doi: 10.1007/s11606-010-1402-1. Epub 2010 May 29.
- Katz MH. Golden gate to health care for all? San Francisco's new universal-access program. N Engl J Med. 2008 Jan 24;358(4):327-9. doi: 10.1056/NEJMp0706590. No abstract available.
- Bindman AB, Chen A, Fraser JS, Yee HF Jr, Ofman D. Healthcare reform with a safety net: lessons from San Francisco. Am J Manag Care. 2009 Oct;15(10):747-50.
- Weiner M, El Hoyek G, Wang L, Dexter PR, Zerr AD, Perkins AJ, James F, Juneja R. A web-based generalist-specialist system to improve scheduling of outpatient specialty consultations in an academic center. J Gen Intern Med. 2009 Jun;24(6):710-5. doi: 10.1007/s11606-009-0971-3. Epub 2009 Apr 15.
- Fischer BS, Martinez E, Driscoll M, Conway T. Practice profile. Chicago: using evidence-based rules to make smarter referrals. Health Aff (Millwood). 2010 May;29(5):972-5. doi: 10.1377/hlthaff.2010.0068. No abstract available.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 1023
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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