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Kurek AA, Boone-Sautter KM, Rizor M, Vermeesch K, Ahmed A. Implementation of E-Consults in an Integrated Health System for a Value Population. Popul Health Manag 2023; 26:303-308. [PMID: 37471229 DOI: 10.1089/pop.2023.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
The adoption of e-consults, a form of formal, asynchronous provider-to-provider communication in which specialty medical advice is sought, has been proven to reduce unnecessary specialty consultations, build provider relationships, and reduce fragmentation of care. While the utilization of e-consults is generally a well-accepted alternative method of incorporating specialist expertise into a patient's plan of care and adoption has become common, the implementation of this disruptive care delivery modality can be challenging. This article seeks to describe the process and operational outcomes of e-consult adoption in an integrated health system with a focus on the benefits in the context of value-based care. Implications of e-consult adoption on referral volumes, wait times, and cancellation rates at the service line level are investigated. E-consult adoption and completion metrics, including utilization, completed versus rejected, turn-around times, and projected cost savings, are also discussed.
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Affiliation(s)
- Alexis A Kurek
- Department of Population Health, Corewell Health West, Grand Rapids, Michigan, USA
| | | | - Michelle Rizor
- Department of Population Health, Corewell Health West, Grand Rapids, Michigan, USA
| | - Kristyn Vermeesch
- Department of Population Health, Corewell Health West, Grand Rapids, Michigan, USA
| | - Aiesha Ahmed
- Department of Population Health, Corewell Health West, Grand Rapids, Michigan, USA
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Rabinowicz R, Maguire B, Hitzler J, Punnett A. How essential are in-person clinic visits during maintenance treatment of children with acute lymphoblastic leukemia? Pediatr Blood Cancer 2022; 69:e29713. [PMID: 35404534 DOI: 10.1002/pbc.29713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is the most common cancer in children. Treatment consists of an initial intensive phase of chemotherapy, followed by a prolonged period of maintenance chemotherapy intended to reduce the risk of relapse. During the COVID-19 pandemic, the need arose to identify and reduce non-essential hospital visits. OBJECTIVE We aimed to determine which proportion of in-person clinic visits during ALL maintenance therapy was associated with a change of management based on the results of the physical examination. PATIENTS AND METHODS Medical records of children receiving maintenance chemotherapy for B-precursor ALL between September 2019 and February 2020 were reviewed. Visits with a new finding on physical examination were divided into those where an in-person assessment was deemed essential versus not essential. Finally, we determined the proportion of essential in-person visits that resulted in a change of management. RESULTS A total of 240 maintenance visits by 75 children were analyzed. An abnormal finding on physical examination was noted during 20 visits (8.3%). Of those, 14 (5.8%) uncovered a new finding, six (2.5%) were classified as "in-person visit essential," and among those six visits, three (1.2%) resulted in a change of patient management (one for acute otitis media, one for wheezing, and one for limp). CONCLUSION Our findings support the evaluation of care delivery models other than in-person visits during ALL maintenance therapy. A prospective study is required to delineate criteria, benefits/risks, and families' perspectives associated with virtual care delivery and the optimal frequency of in-person visits.
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Affiliation(s)
- Ron Rabinowicz
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bryan Maguire
- Biostatistics, Design and Analysis, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Johann Hitzler
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Developmental and Stem Cell Biology, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Angela Punnett
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Tempelaar W, Barwick M, Crawford A, Voineskos A, Addington D, Addington J, Alexander T, Baluyut C, Bromley S, Durbin J, Foussias G, Ford C, de Freitas L, Jindani S, Kirvan A, Kurdyak P, Pauly K, Polillo A, Roby R, Sockalingam S, Sosnowski A, Villanueva V, Wang W, Kozloff N. Adapting Evidence-Based Early Psychosis Intervention Services for Virtual Delivery: Protocol for a Pragmatic Mixed Methods Implementation and Evaluation Study. JMIR Res Protoc 2021; 10:e34591. [PMID: 34806990 PMCID: PMC8653974 DOI: 10.2196/34591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Timely and comprehensive treatment in the form of early psychosis intervention (EPI) has become the standard of care for youth with psychosis. While EPI services were designed to be delivered in person, the COVID-19 pandemic required many EPI programs to rapidly transition to virtual delivery, with little evidence to guide intervention adaptations or to support the effectiveness and satisfaction with virtual EPI services. OBJECTIVE This study aims to explore the adaptations required to deliver NAVIGATE, a model of coordinated specialty care used in EPI, in a virtual format. This study will evaluate implementation of the NAVIGATE model delivered virtually by describing the nature of the adaptations to the intervention, assessing fidelity to the EPI model and the satisfaction of clients, family members, and care providers. We will investigate barriers and facilitators to virtual NAVIGATE implementation, service engagement, and health equity impacts of this work. METHODS The Centre for Addiction and Mental Health (Toronto, Ontario, Canada) transitioned to delivering NAVIGATE virtually early in the COVID-19 pandemic. The Framework for Reporting Adaptations and Modifications for Evidence-Based Interventions will be used to describe the adaptations required to deliver NAVIGATE virtually. Fidelity to the EPI model will be measured using the First Episode Psychosis Services Fidelity Scale and fidelity to NAVIGATE will be assessed by investigating adherence to its core components. Implementation facilitators and barriers will be explored using semistructured interviews with providers informed by the Consolidated Framework for Implementation Research. Satisfaction with virtually delivered NAVIGATE will be assessed with virtual client and provider experience surveys and qualitative interviews with clients, family members, and providers. Service engagement data will be collected through review of medical records, and potential impacts of virtually delivered NAVIGATE on different population groups will be assessed with the Health Equity Impact Assessment. RESULTS Virtual clinical delivery of NAVIGATE started in March 2020 with additional adaptations and data collection is ongoing. Data will be analyzed using descriptive statistics and survival analysis for quantitative data. Qualitative data will be analyzed using thematic content analysis. Integration of qualitative and quantitative data will occur at the data collection, interpretation, and reporting levels following a convergent design. CONCLUSIONS This study will provide information regarding the type of intervention adaptations required for virtual delivery of NAVIGATE for youth with early psychosis, ensuring access to high-quality care for this population during the pandemic and beyond by guiding future implementation in similar contexts. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34591.
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Affiliation(s)
- Wanda Tempelaar
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Melanie Barwick
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Allison Crawford
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Aristotle Voineskos
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Donald Addington
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jean Addington
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Crystal Baluyut
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Bromley
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Janet Durbin
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - George Foussias
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Catherine Ford
- Mental Health Addiction, Ontario Ministry of Health, Toronto, ON, Canada
| | - Lauren de Freitas
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Seharish Jindani
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anne Kirvan
- Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Kirstin Pauly
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexia Polillo
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rachel Roby
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexandra Sosnowski
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- College of Public Health, University of South Florida, Tampa, FL, United States
| | - Nicole Kozloff
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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