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Rahman B, Babe G, Griffith LE, Price D, Lapointe-Shaw L, Costa AP. Patients report high information coordination between rostered primary care physicians and specialists: A cross-sectional study. PLoS One 2024; 19:e0307611. [PMID: 39172961 PMCID: PMC11340953 DOI: 10.1371/journal.pone.0307611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/02/2024] [Indexed: 08/24/2024] Open
Abstract
Our study aimed to describe patient experience of information coordination between their primary care physician and specialists and to examine the associations between their experience and their personal and primary care characteristics. We conducted a cross-sectional study of Ontario residents rostered to a primary care physician and visited a specialist physician in the previous 12 months by linking population-based health administrative data to the Health Care Experience Survey collected between 2013 and 2020. We described respondents' sociodemographic and health care utilization characteristics and their experience of information coordination between their primary care physician and specialists. We measured the adjusted association between patient-reported measures of information coordination before and after respondents received care from a specialist physician and their type of primary care model. 1,460 out 20,422 (weighted 7.5%) of the respondents reported that their specialist physician did not have basic medical information about their visit from their primary care physician in the previous 12 months. 2,298 out of 16,442 (weighted 14.9%) of the respondents reported that their primary care physician seemed uninformed about the care they received from the specialist. Females, younger individuals, those with a college or undergraduate level of education, and users of walk-in clinics had a higher likelihood of reporting a lack of information coordination between the primary care and specialist physicians. Only respondents rostered to an enhanced fee-for-service model had a higher odds of reporting that the specialist physician did not have basic medical information about their visit compared to those rostered to a Family Health Team (OR 1.22, 95% Cl 1.12-1.40). We found no significant association between respondent's type of primary care model and that their primary care physician was uninformed about the care received from the specialist physician. In this population-based health study, respondents reported high information coordination between their primary care physician and specialists. Except for respondents rostered to an enhanced fee-for-service model of care, we did not find any difference in information coordination across other primary care models.
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Affiliation(s)
- Bahram Rahman
- Physician and Provider Services Division, Ministry of Health, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Glenda Babe
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Lauren E. Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David Price
- McMaster Family Health Team, Hamilton, Ontario, Canada
- Medical School, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lauren Lapointe-Shaw
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women’s College Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
| | - Andrew P. Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- The Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- Centre for Integrated Care, St. Joseph’s Health System, Hamilton, Ontario, Canada
- Schlegel Research Institute for Aging, Waterloo, Ontario, Canada
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Walløe S, Roikjær SG, Hansen SMB, Zangger G, Mortensen SR, Korfitsen CB, Simonÿ C, Lauridsen HH, Morsø L. Content validity of patient-reported measures evaluating experiences of the quality of transitions in healthcare settings-a scoping review. BMC Health Serv Res 2024; 24:828. [PMID: 39039533 PMCID: PMC11265152 DOI: 10.1186/s12913-024-11298-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024] Open
Abstract
No reviews so far have been conducted to define the constructs of patient-experienced quality in healthcare transitions or to identify existing generic measures of patients' experience of the quality within healthcare transitions. Our aim was to identify domains relevant for people experiencing healthcare transitions when evaluating the quality of care they have received, map the comprehensiveness of existing patient-reported experience measures (PREM), and evaluate the PREMs' content validity. The method was guided by the Joanna Briggs Institutes' guidance for scoping reviews. The search was performed on 07 December 2021 and updated 27 May 2024, in the electronic databases Medline (Ovid), Embase (Ovid), and Cinahl (EBSCO). The search identified 20,422 publications, and 190 studies were included for review. We identified 30 PREMs assessing at least one aspect of adults' experience of transitions in healthcare. Summarising the content, we consider a model with two domains, organisational and human-relational, likely to be adequate. However, a more comprehensive analysis and adequate definition of the construct is needed. None of the PREMs were considered content valid.
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Affiliation(s)
- Sisse Walløe
- Department of Clinical Research, Research Unit OPEN, University of Southern Denmark, Odense, Denmark.
- Department of Physio- and Occupational Therapy, Research- and Implmentation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark.
| | - Stine Gundtoft Roikjær
- Department of Physio- and Occupational Therapy, Research- and Implmentation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Neurology, Center for Neurological Research, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Health, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sebrina Maj-Britt Hansen
- Department of Clinical Research, Research Unit OPEN, University of Southern Denmark, Odense, Denmark
| | - Graziella Zangger
- Department of Physio- and Occupational Therapy, Research- and Implmentation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Sofie Rath Mortensen
- Department of Physio- and Occupational Therapy, Research- and Implmentation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Christoffer Bruun Korfitsen
- Department of Clinical Research, Research Unit OPEN, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Cochrane Denmark & Centre for Evidence-Based Medicine Odense (CEBMO), University of Southern Denmark, Odense, Denmark
| | - Charlotte Simonÿ
- Department of Physio- and Occupational Therapy, Research- and Implmentation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Health, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Hein Lauridsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars Morsø
- Department of Clinical Research, Research Unit OPEN, University of Southern Denmark, Odense, Denmark
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Maria ARJ, Serra H, Castro MG, Heleno B. Interaction at the primary–secondary care interface: Patients’ and physicians’ perceptions of teleconsultations. Digit Health 2022; 8:20552076221133698. [PMCID: PMC9716594 DOI: 10.1177/20552076221133698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 10/02/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Previous qualitative research on teleconsultations has focused on synchronous communication between a patient and a clinician. This study aims to explore physicians' and patients' perceptions of the interaction on the interface between primary care and the Cardiology service of a referral hospital through teleconsultations. Methods This qualitative study was embedded in an organizational case study concerning the introduction and rollout of a new service model that took place at the point of care. The patients and physicians were recruited for semi-structured interviews until thematic saturation was achieved, between September 2019 - January 2020. The interviews were audiorecorded and anonymized. The transcribed interviews were stored, coded, and analyzed in MAXQDA, following the steps for conventional content analysis. Results A total of 29 participants were interviewed. Patients and physicians presented clear views about the role of the GP and the cardiologist and their function in overall structure of healthcare. GPs felt their role was to bring expertise in the patient which could supplement the cardiologists' expertise on the condition. However, GPs had to renegotiate roles in the teleconsultations when they saw themselves in a new situation, together with another physician and the patient. Conclusions Our findings suggest that joint teleconsultations can promote continuity of care for patients in the primary/secondary care interface. Active coordination between physicians with delineation of roles throughout primary-secondary care interface is needed to manage selected patients who may benefit the most from shared care.
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Affiliation(s)
- Ana Rita J Maria
- Regional Health Administration of Lisbon and Tagus Valley, Comprehensive Health Research Centre (CHRC), Nova Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal,Ana Rita J Maria, Campo dos Mártires da Pátria 130, 1169–056, Lisboa, Portugal.
| | - Helena Serra
- Interdisciplinary Centre of Social Sciences (CICS. NOVA), NOVA School of Social Sciences and Humanities
- Faculdade de Ciências Sociais e Humanas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Maria G Castro
- Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Bruno Heleno
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa; General Practitioner, Regional Health Administration of Lisbon and Tagus Valley, Lisbon, Portugal
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Wright JR, Madhusudhan DK, Lawrence DC, Watts SA, Lord DJ, Whaley C, Bravata DM. Costs of Specialist Referrals From Employer-Sponsored Integrated Health Care Clinics Are Lower Than Those From Community Providers. J Gen Intern Med 2022; 37:3861-3868. [PMID: 35882712 PMCID: PMC9321287 DOI: 10.1007/s11606-022-07724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 06/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND There have been very few published studies of referral management among commercially insured populations and none on referral management from employer-sponsored health centers. OBJECTIVE Describe the referral management system of an integrated employer-sponsored health care system and compare specialist referral rates and costs of specialist visits between those initiated from employer-sponsored health clinics and those initiated from community providers. DESIGN Retrospective, comparative cohort study using multivariate analysis of medical claims comparing care initiated in employer-sponsored health clinics with propensity-matched controls having specialist referrals initiated by community providers. PATIENTS Adult patients (≥ 18 years) eligible for employer-sponsored clinical services incurring medical claims for specialist referrals between 12/1/2018 and 12/31/2020. The study cohort was comprised of 3129 receiving more than 75% of their care in the employer-sponsored clinic matched to a cohort of 3129 patients receiving care in the community. INTERVENTION Specialist referral management program implemented by Crossover Health employer-sponsored clinics. MAIN MEASURES Rates and costs of specialist referrals. KEY RESULTS The relative rate of specialist referrals was 22% lower among patients receiving care in employers-sponsored health clinics (35.1%) than among patients receiving care in the community (45%, p <0.001). The total per-user per-month cost for patients in the study cohort was $372 (SD $894), compared to $401 (SD $947) for the community cohort, a difference of $29 (p<0.001) and a relative reduction of 7.2%. The lower costs can be attributed, in part, to lower specialist care costs ($63 (SD $140) vs $76 (SD $213) (p<0.001). CONCLUSIONS Employer-sponsored health clinics can provide effective integrated care and may be able to reduce avoidable specialist utilization. Standardized referral management and care navigation may drive lower specialist spend, when referrals are needed.
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Affiliation(s)
| | - Divya K Madhusudhan
- Crossover Health, San Clemente, CA, USA.,Harvard Medical School Postgraduate Medical Education, Global Clinical Scholars Research Training Program, Boston, MA, USA
| | | | - Sharon A Watts
- Crossover Health, San Clemente, CA, USA.,Watts Writing LLC, Akron, OH, USA
| | | | | | - Dena M Bravata
- Crossover Health, San Clemente, CA, USA. .,Stanford Center for Primary Care & Outcomes Research, Palo Alto, CA, USA. .,, San Mateo, USA.
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Glushko T, Teytelboym O, Cook T. Impact of PTRIA (Patient Test Result Information Act) on patient follow up management. Clin Imaging 2021; 79:20-23. [PMID: 33865172 DOI: 10.1016/j.clinimag.2021.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/14/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We aim to study if direct patient notification in accordance with the Patient Test Results Information Act (Act 112) in Pennsylvania leads to decreased loss to follow up and prompt management of actionable imaging findings. METHODS For this IRB-approved study, radiology reports were randomly identified using the Nuance mPower™ search engine. The actionable finding group (prior to Act-112) contained 300 patients for which a voice notification was sent by radiologists to alert ordering physicians about significant imaging findings. The PTRIA group (after Act-112) contained 300 patients who were mailed a standardized letter one day after the final report was issued. The electronic medical records were reviewed to evaluate how patients were managed. RESULTS There was no difference in loss to follow up rates and time to follow up completion between the two groups. In both groups, 34% of patients were lost to follow up in transition of care from generalists to specialists; 24% cases were lost to follow up when imaging findings were not in the area of the initial ordering provider expertise. CONCLUSION The goal of Act 112 is to increase patients' role in the timely management of their significant medical conditions and prevent medical errors, specifically loss to follow up. Our study suggests that presumed patients' awareness does not contribute to improved follow up rates or decreased time to a follow up visit. 13% of patients are lost to follow up in both groups. A tracking system is required to prevent delayed management of the significant findings.
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Affiliation(s)
- Tetiana Glushko
- Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Diagnostic Radiology, 601 N. Caroline Street, JHOC 3235-A, Baltimore, MD 21287, United States of America.
| | - Oleg Teytelboym
- Mercy Catholic Medical Center, Radiology Department, 1500 Lansdowne Ave, Darby, PA 19023, United States of America
| | - Tessa Cook
- Hospital of the University of Pennsylvania, Department of Radiology, 3400 Spruce Street, 1, Silverstein Ste. 130, Philadelphia, PA 19104, United States of America. https://twitter.com/asset25
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Assessing Patient Satisfaction and Experience With an Electronic Referral Process. Qual Manag Health Care 2021; 29:20-29. [PMID: 31855932 DOI: 10.1097/qmh.0000000000000235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Our study aimed to identify patients' perception of an eReferral process and e-mail notification system. METHODS Patients within the Waterloo Wellington Local Health Integration Network who registered their e-mail address with physicians who adopted the eReferral system, and therefore received e-mail notifications of their booked appointment, were invited to complete an online satisfaction survey. This patient experience survey is an ongoing online link embedded within the confirmation e-mail of the booked appointment. The survey is hosted on the eReferral solution platform and has been operational since November 2017. The survey consists of 8 questions with 3 main categories to assess patients' opinion of their experience of the referral process and notification system using a 5-point Likert scale and open-ended questions. RESULTS A total of 545 patients have completed the patient satisfaction survey within this reporting period with a response rate of 15%. In general, 94% of patients agreed that receiving a confirmation e-mail of their booked appointment had improved their experience with the referral process. The majority (94%) agreed that the eReferral process was easy to follow, and 83% agreed that they were able to get the care they needed within a reasonable time. Compared with their past referral experiences, 80% of patients felt more informed throughout this electronic referral process. Using binominal logistic regression, participants whose preferences were considered had 8.06 times higher odds to exhibit satisfaction with the referral process than those who did not. Patients' qualitative responses identified the eReferral process as being quick, efficient, and resulting in a sense of being in control of their own health care. There are some limitations to the system felt by some of the patients who responded to the open-ended questions of the survey. Patients identified the need to add a complementary structure to the notification design consisting of multiple dates and times with a chance to pick the appointment that suits patients best instead of being restricted to only 1 appointment date. A few patients thought that the heading of the e-mail notification system should be more distinguishable for easier tracking. Furthermore, some patients felt the need to add some notes to the initial e-mail advising patients of the next steps throughout their referral process. CONCLUSION eReferral has improved patients' experience with the referral process. Our findings in this study would support the solution vendor in its efforts to refine and enhance active communication channels with patients for sustainable health care that meets patients' expectations and needs.
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Satisfaction With Healthcare Services Among Patients With Diabetes, Hypertension, and/or Dyslipidemia in Mexico: A Cross-Sectional Study. Value Health Reg Issues 2020; 23:19-24. [DOI: 10.1016/j.vhri.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/05/2019] [Accepted: 11/18/2019] [Indexed: 11/20/2022]
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Scaioli G, Schäfer WLA, Boerma WGW, Spreeuwenberg P, van den Berg M, Schellevis FG, Groenewegen PP. Patients' perception of communication at the interface between primary and secondary care: a cross-sectional survey in 34 countries. BMC Health Serv Res 2019; 19:1018. [PMID: 31888614 PMCID: PMC6937702 DOI: 10.1186/s12913-019-4848-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor communication between general practitioners (GPs) and medical specialists can lead to poorer quality, and continuity, of care. Our study aims to assess patients' perceptions of communication at the interface between primary and secondary care in 34 countries. It will analyse, too, whether this communication is associated with the organisation of primary care within a country, and with the characteristics of GPs and their patients. METHODS We conducted a cross-sectional survey among patients in 34 countries. Following a GP consultation, patients were asked two questions. Did they take to understand that their GP had informed medical specialists about their illness upon referral? And, secondly, did their GP know the results of the treatment by a medical specialist? We used multi-response logistic multilevel models to investigate the association of factors related to primary care, the GP, and the patient, with the patients' perceptions of communication at the interface between primary and secondary care. RESULTS In total, 61,931 patients completed the questionnaire. We found large differences between countries, in both the patients' perceptions of information shared by GPs with medical specialists, and the patients' perceptions of the GPs' awareness of the results of treatment by medical specialists. Patients whose GPs stated that they 'seldom or never' send referral letters, also less frequently perceived that their GP communicated with their medical specialists about their illness. Patients with GPs indicating they 'seldom or never' receive feedback from medical specialists, indicated less frequently that their GP would know the results of treatment by a medical specialist. Moreover, patients with a personal doctor perceived higher rates of communication in both directions at the interface between primary and secondary care. CONCLUSION Generally, patients perceive there to be high rates of communication at the interface between primary and secondary care, but there are large differences between countries. Policies aimed at stimulating personal doctor arrangements could, potentially, enhance the continuity of care between primary and secondary care.
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Affiliation(s)
- Giacomo Scaioli
- Department of Public Health Sciences, University of Turin, Piazza Polonia, 94, 10126, Torino, Italy
| | - Willemijn L A Schäfer
- Department of Surgery, Northwestern University, Feinberg School of Medicine, 633 N. St Clair Street, Chicago, IL, 60611, USA
| | - Wienke G W Boerma
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands
| | - Peter Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands
| | - Michael van den Berg
- Department of Public Health, Amsterdam Public Health Research Institute, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - François G Schellevis
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands.,Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Peter P Groenewegen
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands. .,Department of Sociology, P.O. Box 80.115, 3508 TC, Utrecht, The Netherlands. .,Department of Human Geography, Utrecht University, P.O. Box 80.115, 3508 TC, Utrecht, The Netherlands.
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Ramelson H, Nederlof A, Karmiy S, Neri P, Kiernan D, Krishnamurthy R, Allen A, Bates DW. Closing the loop with an enhanced referral management system. J Am Med Inform Assoc 2019; 25:715-721. [PMID: 29471355 DOI: 10.1093/jamia/ocy004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/07/2018] [Indexed: 12/17/2022] Open
Abstract
Objective To evaluate the impact of a referral manager tool on primary care practices. Materials and Methods We evaluated a referral manager module in a locally developed electronic health record (EHR) that was enhanced to improve the referral management process in primary care practices. Baseline (n = 61) and follow-up (n = 35) provider and staff surveys focused on the ease of performing various steps in the referral process, confidence in completing those steps, and user satisfaction. Additional metrics were calculated that focused on completed specialist visits, acknowledged notes, and patient communication. Results Of 1341 referrals that were initiated during the course of the study, 76.8% were completed. All the steps of the referral process were easier to accomplish following implementation of the enhanced referral manager module in the EHR. Specifically, tracking the status of an in-network referral became much easier (+1.43 [3.91-2.48] on a 5-point scale, P < .0001). Although we found improvement in the ease of performing out-of-network referrals, there was a greater impact on in-network referrals. Discussion Implementation of an electronic tool developed using user-centered design principles along with adequate staff to monitor and intervene when necessary made it easier for primary care practices to track referrals and to identify if a breakdown in the process occurred. This is especially important for high-priority referrals. Out-of-network referrals continue to present challenges, which may eventually be helped by improving interoperability among EHRs and scheduling systems. Conclusion An enhanced referral manager system can improve referral workflows, leading to enhanced efficiency and patient safety and reduced malpractice risk.
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Affiliation(s)
- Harley Ramelson
- Information Systems, Partners HealthCare, Somerville, MA, USA.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Amanda Nederlof
- Information Systems, Partners HealthCare, Somerville, MA, USA
| | - Sam Karmiy
- Information Systems, Partners HealthCare, Somerville, MA, USA
| | - Pamela Neri
- Information Systems, Partners HealthCare, Somerville, MA, USA
| | - David Kiernan
- Information Systems, Partners HealthCare, Somerville, MA, USA
| | | | | | - David W Bates
- Information Systems, Partners HealthCare, Somerville, MA, USA.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
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Nabelsi V, Lévesque-Chouinard A, Liddy C, Dumas Pilon M. Improving the Referral Process, Timeliness, Effectiveness, and Equity of Access to Specialist Medical Services Through Electronic Consultation: Pilot Study. JMIR Med Inform 2019; 7:e13354. [PMID: 31293239 PMCID: PMC6652123 DOI: 10.2196/13354] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/22/2019] [Accepted: 06/05/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Access to specialty care remains a major challenge in the Canadian health care system. Electronic consultation (eConsult) services allow primary care providers to seek specialist advice often without needing the patient to go for a face-to-face consultation. It improves overall access to specialists and the referral process using an electronic care consultation service in urban and rural primary care clinics. This study describes the preliminary results of a pilot study with an eConsult service across 3 regions in the province of Quebec, Canada. OBJECTIVE The main objective of this study was to provide a 1-year snapshot of the implementation of the eConsult Quebec Service in rural and urban primary care clinics to improve access to care and the specialty referral process for primary care providers (PCPs). METHODS We established an eConsult service that covers urban and rural communities in 3 regions of Quebec. We conducted a quantitative analysis of all eConsult cases submitted from July 4, 2017, to December 8, 2018. RESULTS For over a year, 1016 eConsults have been generated during the course of this study. A total of 97 PCPs submitted requests to 22 specialty groups and were answered by 40 different specialists. The most popular specialty was internal medicine (224/1016, 22%). Overall, 63% (640/1016) of completed cases did not require a face-to-face visit. PCPs rated the service as being of high or very high value for themselves in 98% (996/1016) of cases. CONCLUSIONS The preliminary data highlight the success of the implementation of the eConsult Quebec Service across 6 primary care clinics. The eConsult platform proves to be effective, efficient, and well received by both patients and physicians. If used more widely, eConsult could help reducing wait times significantly. Recently, the Ministry of Health and Social Services of Quebec has identified developing a strategic plan to scale eConsults throughout other regions of the province as a top priority.
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Affiliation(s)
- Véronique Nabelsi
- Département des Sciences Administratives, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Annabelle Lévesque-Chouinard
- Groupe de Médecine de Famille Universitaires de Gatineau du Centre Intégré de Santé et des Services Sociaux de l'Outaouais, Gatineau, QC, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, ON, Canada.,CT Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Maxine Dumas Pilon
- Department of Family Medicine, McGill University, Montréal, QC, Canada.,Collège Québécois des Médecins de Famille, Montréal, QC, Canada
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11
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De Regge M, De Pourcq K, Meijboom B, Trybou J, Mortier E, Eeckloo K. The role of hospitals in bridging the care continuum: a systematic review of coordination of care and follow-up for adults with chronic conditions. BMC Health Serv Res 2017; 17:550. [PMID: 28793893 PMCID: PMC5551032 DOI: 10.1186/s12913-017-2500-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 08/02/2017] [Indexed: 12/19/2022] Open
Abstract
Background Multiple studies have investigated the outcome of integrated care programs for chronically ill patients. However, few studies have addressed the specific role hospitals can play in the downstream collaboration for chronic disease management. Our objective here is to provide a comprehensive overview of the role of the hospitals by synthesizing the advantages and disadvantages of hospital interference in the chronic discourse for chronically ill patients found in published empirical studies. Method Systematic literature review. Two reviewers independently investigated relevant studies using a standardized search strategy. Results Thirty-two articles were included in the systematic review. Overall, the quality of the included studies is high. Four important themes were identified: the impact of transitional care interventions initiated from the hospital’s side, the role of specialized care settings, the comparison of inpatient and outpatient care, and the effect of chronic care coordination on the experience of patients. Conclusion Our results show that hospitals can play an important role in transitional care interventions and the coordination of chronic care with better outcomes for the patients by taking a leading role in integrated care programs. Above that, the patient experiences are positively influenced by the coordinating role of a specialist. Specialized care settings, as components of the hospital, facilitate the coordination of the care processes. In the future, specialized care centers and primary care could play a more extensive role in care for chronic patients by collaborating.
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Affiliation(s)
- Melissa De Regge
- Faculty of Economics and Business Administration, Department of Innovation, Entrepreneurship, and Service Management, Ghent University, Tweekerkenstraat 2, B-9000, Ghent, Belgium. .,Department of Strategic Policy Cell, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Kaat De Pourcq
- Faculty of Economics and Business Administration, Department of Innovation, Entrepreneurship, and Service Management, Ghent University, Tweekerkenstraat 2, B-9000, Ghent, Belgium
| | - Bert Meijboom
- Faculty of Economics, Department of Management, Tilburg University, Tilburg, The Netherlands.,Department Tranzo, Tilburg University, Tilburg, The Netherlands
| | - Jeroen Trybou
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, Belgium
| | - Eric Mortier
- Faculty of Medicine and Health Sciences, Department of Anaesthesiology, Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Kristof Eeckloo
- Department of Strategic Policy Cell, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, Belgium
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12
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Hendrickson CD, Saini S, Pothuloori A, Mecchella JN. ASSESSING REFERRALS AND IMPROVING INFORMATION AVAILABILITY FOR CONSULTATIONS IN AN ACADEMIC ENDOCRINOLOGY CLINIC. Endocr Pract 2016; 23:190-198. [PMID: 27849384 DOI: 10.4158/ep161514.or] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Outpatient specialty consultations rely on the timeliness and completeness of referral information to facilitate a valuable patient-specialist interaction. This project aimed to increase essential diagnostic information availability at the initial consultation for patients referred for common endocrine conditions frequently lacking such data-diabetes mellitus, thyroid nodule, thyrotoxicosis, and hypercalcemia. METHODS At an endocrinology clinic at an academic medical center in rural New England, providers see several thousand new patients annually, the majority of whom are referred by providers external to the clinic's healthcare system. Through consensus, endocrinology clinic providers agreed on the two or three data elements essential for a meaningful initial consultation for each. A quality improvement team employed a planned series of interventions based on previously published methods and an innovative approach: dissemination of a referral guideline, an assessment of referral adequacy in the endocrinology clinic workflow, coupled with focused requests for missing items, and a pre-visit lab appointment. RESULTS Between April 2015 and March 2016, 762 referrals were reviewed. At baseline for the four conditions, referrals contained all essential elements only 27.5% (22 of 80) of the time. Over a 7-month period, the team implemented the interventions, with subsequent referrals containing all essential elements increasing to 75.5% (P<.0001), largely attributable to the pre-visit lab appointment. CONCLUSION Incoming referrals that lack essential information are a significant problem in specialty care and may adversely affect patient experience, provider satisfaction, and clinic efficiency. Improvement may require innovative approaches, such as the potentially transferable and generalizable ones employed here. ABBREVIATIONS DHMC = Dartmouth-Hitchcock Medical Center EHR = electronic health record PDSA = Plan-Do-Study-Act.
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13
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Kirsh SR, Ho PM, Aron DC. Providing specialty consultant expertise to primary care: an expanding spectrum of modalities. Mayo Clin Proc 2014; 89:1416-26. [PMID: 24889514 DOI: 10.1016/j.mayocp.2014.04.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/11/2014] [Accepted: 04/16/2014] [Indexed: 01/18/2023]
Abstract
In most models of health care delivery, the bulk of services are provided in primary care and there is frequent request for the input of specialty consultants. A critical issue for current and future health care systems is the effective and efficient delivery of specialist expertise for clinicians and patients. Input on a patient's care from specialty consultants usually requires a face-to-face visit between the patient and the consultant. New and complementary models of knowledge sharing have emerged. We describe a framework assessment of a spectrum of knowledge-sharing methods in the context of a patient-centered medical home. This framework is based on our experience in the Veterans Health Administration and a purposive review of the literature. These newer modes of specialty consultation include electronic consultation, secure text messaging, telemedicine of various types, and population preemptive consults. In addition to describing these modes of consultation, our framework points to several important areas in which further research is needed to optimize effectiveness.
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Affiliation(s)
- Susan R Kirsh
- Office of Specialty Care, Veterans Health Administration, Washington, DC; Office of Specialty Care/VA HSR&D QUERI Evaluation Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH; Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - P Michael Ho
- Office of Specialty Care/VA HSR&D QUERI Evaluation Center, Eastern Colorado Health Care System Medical Center, Aurora, CO; Department of Medicine, School of Medicine, University of Colorado Denver, Aurora, CO
| | - David C Aron
- Office of Specialty Care/VA HSR&D QUERI Evaluation Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH; Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Organizational Behavior, Weatherhead School of Management, Cleveland, OH.
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14
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Brown MG, Campbell D, Maydom BW. The undivided patient: a retrospective cohort analysis of specialty referrals made from inpatient general medical units comparing regional to metropolitan practice. Intern Med J 2014; 44:884-9. [DOI: 10.1111/imj.12480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/15/2014] [Indexed: 11/26/2022]
Affiliation(s)
- M. G. Brown
- Department of General Medicine; Monash Medical Centre; Melbourne Australia
| | - D. Campbell
- Department of General Medicine; Monash Medical Centre; Melbourne Australia
| | - B. W. Maydom
- Department of Medicine; West Gippsland Heath Care Group; Warragul Victoria Australia
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15
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Aller MB, Vargas I, Waibel S, Coderch-Lassaletta J, Sánchez-Pérez I, Llopart JR, Colomés L, Ferran M, Garcia-Subirats I, Vázquez Navarrete ML. Factors associated to experienced continuity of care between primary and outpatient secondary care in the Catalan public healthcare system. GACETA SANITARIA 2012; 27:207-13. [PMID: 22981418 DOI: 10.1016/j.gaceta.2012.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/15/2012] [Accepted: 06/26/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze patient's reported elements of relational, informational and managerial (dis)continuity between primary and outpatient secondary care and to identify associated factors. METHODS Cross-sectional study by means of a survey of a random sample of 1500 patients attended in primary and secondary care for the same condition. The study settings consisted of three health areas of the Catalan health system. Data were collected in 2010 using the CCAENA questionnaire, which identifies patients' experiences of continuity of care. Descriptive analyses and multivariable logistic regression models were carried out. RESULTS Elements of continuity of care were experienced by most patients. However, elements of discontinuity were also identified: 20% and 15% were seen by more than one primary or secondary care physician, respectively. Their secondary care physician or both professionals were identified as responsible for their care by 40% and 45% of users, respectively. Approximately 20% reported a lack of information transfer. Finally, 72% of secondary care consultations were due to primary care referral, whilst only 36% reported a referral back to primary care. Associated factors were healthcare setting, age, sex, perceived health status and disease duration. CONCLUSION Users generally reported continuity of care, although elements of discontinuity were also identified, which can be partially explained by the healthcare setting and some individual factors. Elements of discontinuity should be addressed to better adapt care to patients' needs.
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Affiliation(s)
- Marta-Beatriz Aller
- Grupo de Investigación en Políticas de Salud y Servicios Sanitarios, Servicio de Estudios y Prospectivas en Políticas de Salud, Consorcio de Salud y Social de Cataluña, Barcelona, Spain.
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16
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Welch AE, Caramanica K, Debchoudhury I, Pulizzi A, Farfel MR, Stellman SD, Cone JE. A qualitative examination of health and health care utilization after the September 11th terror attacks among World Trade Center Health Registry enrollees. BMC Public Health 2012; 12:721. [PMID: 22935548 PMCID: PMC3490950 DOI: 10.1186/1471-2458-12-721] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 06/25/2012] [Indexed: 11/23/2022] Open
Abstract
Background Many individuals who have 9/11-related physical and mental health symptoms do not use or are unaware of 9/11-related health care services despite extensive education and outreach efforts by the World Trade Center (WTC) Health Registry (the Registry) and various other organizations. This study sought to evaluate Registry enrollees’ perceptions of the relationship between physical and mental health outcomes and 9/11, as well as utilization of and barriers to 9/11-related health care services. Methods Six focus groups were conducted in January 2010 with diverse subgroups of enrollees, who were likely eligible for 9/11-related treatment services. The 48 participants were of differing race/ethnicities, ages, and boroughs of residence. Qualitative analysis of focus group transcripts was conducted using open coding and the identification of recurring themes. Results Participants described a variety of physical and mental symptoms and conditions, yet their knowledge and utilization of 9/11 health care services were low. Participants highlighted numerous barriers to accessing 9/11 services, including programmatic barriers (lack of program visibility and accessibility), personal barriers such as stigmatization and unfamiliarity with 9/11-related health problems and services, and a lack of referrals from their primary care providers. Moreover, many participants were reluctant to connect their symptoms to the events of 9/11 due to lack of knowledge, the amount of time that had elapsed since 9/11, and the attribution of current health symptoms to the aging process. Conclusions Knowledge of the barriers to 9/11-related health care has led to improvements in the Registry’s ability to refer eligible enrollees to appropriate treatment programs. These findings highlight areas for consideration in the implementation of the new federal WTC Health Program, now funded under the James Zadroga 9/11 Health and Compensation Act (PL 111-347), which includes provisions for outreach and education.
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Affiliation(s)
- Alice E Welch
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
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Affiliation(s)
- Alice Hm Chen
- Division of General Internal Medicine, Department of Medicine & Center for Innovation in Access and Quality, University of California, San Francisco at San Francisco General Hospital, Box 1364, San Francisco, CA 94143-1364 USA
| | - Diane Rittenhouse
- Department of Family and Community Medicine & Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA USA
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Fahy BG, Balke CW, Umberger GH, Talbert J, Canales DN, Steltenkamp CL, Conigliaro J. Crossing the chasm: information technology to biomedical informatics. J Investig Med 2012; 59:768-79. [PMID: 21383632 DOI: 10.2310/jim.0b013e31821452bf] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Accelerating the translation of new scientific discoveries to improve human health and disease management is the overall goal of a series of initiatives integrated in the National Institutes of Health (NIH) "Roadmap for Medical Research." The Clinical and Translational Science Award (CTSA) program is, arguably, the most visible component of the NIH Roadmap providing resources to institutions to transform their clinical and translational research enterprises along the goals of the Roadmap. The CTSA program emphasizes biomedical informatics as a critical component for the accomplishment of the NIH's translational objectives. To be optimally effective, emerging biomedical informatics programs must link with the information technology platforms of the enterprise clinical operations within academic health centers.This report details one academic health center's transdisciplinary initiative to create an integrated academic discipline of biomedical informatics through the development of its infrastructure for clinical and translational science infrastructure and response to the CTSA mechanism. This approach required a detailed informatics strategy to accomplish these goals. This transdisciplinary initiative was the impetus for creation of a specialized biomedical informatics core, the Center for Biomedical Informatics (CBI). Development of the CBI codified the need to incorporate medical informatics including quality and safety informatics and enterprise clinical information systems within the CBI. This article describes the steps taken to develop the biomedical informatics infrastructure, its integration with clinical systems at one academic health center, successes achieved, and barriers encountered during these efforts.
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Affiliation(s)
- Brenda G Fahy
- Department of Anesthesiology, College of Medicine, University of Kentucky, Lexington, USA
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Assis EGD, Beraldo AA, Monroe AA, Scatena LM, Cardozo-Gonzales RI, Palha PF, Protti ST, Villa TCS. A coordenação da assistência no controle da tuberculose. Rev Esc Enferm USP 2012; 46:111-8. [DOI: 10.1590/s0080-62342012000100015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 07/11/2011] [Indexed: 11/22/2022] Open
Abstract
Estudo epidemiológico descritivo que analisa a coordenação da assistência ao doente de Tuberculose em Serviços de Atenção Primária segundo 23 doentes, 16 profissionais e 17 gestores em Ribeirão Preto-SP, através de instrumento adaptado para avaliar a tuberculose. De acordo com os informantes, a coordenação da assistência ao doente em tratamento pela equipe do programa de controle da tuberculose foi considerada satisfatória. No entanto, quando há necessidade de encaminhar o doente a outros pontos de atenção, a coordenação da assistência apresenta pontos deficientes como descontinuidade do fluxo de comunicação e participação incipiente do doente no processo de atenção, havendo necessidade de aumentar a responsabilização pelo cuidado do doente e estimulá-lo como agente ativo do processo.
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Huang IC, Kenzik KM, Sanjeev TY, Shearer PD, Revicki DA, Nackashi JA, Shenkman EA. Quality of life information and trust in physicians among families of children with life-limiting conditions. PATIENT-RELATED OUTCOME MEASURES 2010; 2010:141-148. [PMID: 21760753 PMCID: PMC3134229 DOI: 10.2147/prom.s12564] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To examine information that parents of children with life-limiting conditions want to discuss with children’s physicians to assist decision-making, and whether the desire for this information is associated with parents’ trust in physicians. Study design: A cross-sectional study using a telephone survey. Patients and methods: Subjects comprised a random sample of 266 parents whose children were enrolled in Florida’s Medicaid Program. Parents were asked if they wanted to discuss information related to their children’s treatment, including quality of life (QOL), pain relief, spiritual beliefs, clinical diagnosis/laboratory data, changes in the child’s behavior due to treatment, changes in the child’s appearance due to treatment, chances of recovery, and advice from the physician and family/friends. The Wake Forest Physician Trust Scale was used to measure parents’ trust in physicians. We tested the relationships between parents’ age, race/ethnicity, education, parent-reported children’s health status, and the desired information. We also tested whether the desire for information was associated with greater trust in physicians. Results: Most parents wanted information on their children’s QOL (95%), followed by chance of recovery (88%), and pain relief (84%). Compared with nonHispanic whites, nonHispanic blacks and Hispanics showed a greater desire for information and a chance to discuss QOL information had greater trust in their children’s physicians than other information after adjusting for covariates (P < 0.05). Conclusions: Among children with life-limiting conditions, QOL is the most frequently desired information that parents would like to receive from physicians as part of shared decision-making. Parents’ desire for QOL information is associated with greater trust in their children’s physicians.
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Affiliation(s)
- I-Chan Huang
- Department of Health Outcomes and Policy, University of Florida, Gainesville, Florida
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