Clinical trial NCT02376855: A Study of the Implementation of an Electronic Consultation ("eConsult") Platform
Official title: 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 type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Cardiovascular Diseases
Keywords: Health Services Accessibility
Lead sponsor: Community Health Center, Inc.
Sponsor class: INDUSTRY
Collaborators: name: Connecticut Health Foundation
name: University of Connecticut
name: UConn Health
First posted: 2015-03-03
Enrollment: 36
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The purpose of this study is to evaluate the implementation of an electronic consultation model for specialty services (eConsults) to improve quality of care and reduce health system costs. An eConsult is a non-face-to-face consultation between a primary care provider and a specialist that takes place via secure messaging.

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.

Eligibility criteria: Inclusion Criteria:

* Primary Care Provider at Community Health Center, Inc who work at least 30 hours per week and see adult patients

Exclusion Criteria:

-

Primary outcomes:
measure: Time to first contact with a cardiologist
timeFrame: 18 months
Secondary outcomes:
measure: Completion of referrals
timeFrame: 18 months
measure: Adverse events
timeFrame: 18 months
measure: Hospital and Emergency Department Utilization
timeFrame: 18 months
measure: Provider Satisfaction (survey)
timeFrame: Baseline, 6 months, 12 months
measure: Number of in-person cardiology visits
timeFrame: 18 months
measure: Total Cost Per Patient
timeFrame: 6 months pre and 6 months post intervention
Other outcomes:
Locations:
city: Middletown
country: United States
facility: Community Health Center, Inc
state: Connecticut
Study officials:
affiliation: Center for Excellence in Primary Care, University of California, San Francisco
name: J. Nwando Olayiwola, MD, MPH
role: PRINCIPAL_INVESTIGATOR
affiliation: Weitzman Institute, Community Health Center, Inc
name: Daren Anderson, MD
role: PRINCIPAL_INVESTIGATOR
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