NCT02376855

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.

Trial Health

87
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
36

participants targeted

Target at below P25 for not_applicable cardiovascular-diseases

Timeline
Completed

Started Oct 2011

Geographic Reach
1 country

1 active site

Status
completed

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

Study Start

First participant enrolled

October 1, 2011

Completed
1.9 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

September 1, 2013

Completed
3 months until next milestone

Study Completion

Last participant's last visit for all outcomes

December 1, 2013

Completed
1.2 years until next milestone

First Submitted

Initial submission to the registry

February 26, 2015

Completed
5 days until next milestone

First Posted

Study publicly available on registry

March 3, 2015

Completed
Last Updated

March 3, 2015

Status Verified

February 1, 2015

Enrollment Period

1.9 years

First QC Date

February 26, 2015

Last Update Submit

March 2, 2015

Conditions

Cardiovascular Diseases

Keywords

Health Services Accessibility

Outcome Measures

Primary Outcomes (1)

  • Time to first contact with a cardiologist

    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

Secondary Outcomes (6)

  • Completion of referrals

    18 months

  • Adverse events

    18 months

  • Hospital and Emergency Department Utilization

    18 months

  • Provider Satisfaction (survey)

    Baseline, 6 months, 12 months

  • Number of in-person cardiology visits

    18 months

  • +1 more secondary outcomes

Study Arms (2)

Control

NO INTERVENTION

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.

eConsult

EXPERIMENTAL

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.

Other: eConsult

Interventions

eConsultOTHER

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.

eConsult

Eligibility Criteria

Sexall
Healthy VolunteersYes
Age GroupsChild (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

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

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (1)

Community Health Center, Inc

Middletown, Connecticut, 06457, United States

Location

Related Publications (10)

  • 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.

    PMID: 21220663BACKGROUND

  • 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.

    PMID: 21200042BACKGROUND

  • 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.

    PMID: 20439891BACKGROUND

  • 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.

    PMID: 20157139BACKGROUND

  • 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.

    PMID: 19308334BACKGROUND

  • 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.

    PMID: 20512531BACKGROUND

  • 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.

    PMID: 18216352BACKGROUND

  • 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.

    PMID: 19845426BACKGROUND

  • 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.

    PMID: 19367375BACKGROUND

  • 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.

    PMID: 20439892BACKGROUND

MeSH Terms

Conditions

Cardiovascular Diseases

Study Officials

  • 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

    PRINCIPAL INVESTIGATOR

Study Design

Study Type
interventional
Phase
not applicable
Allocation
RANDOMIZED
Masking
SINGLE
Who Masked
INVESTIGATOR
Purpose
HEALTH SERVICES RESEARCH
Intervention Model
PARALLEL
Sponsor Type
INDUSTRY
Responsible Party
SPONSOR

Study Record Dates

First Submitted

February 26, 2015

First Posted

March 3, 2015

Study Start

October 1, 2011

Primary Completion

September 1, 2013

Study Completion

December 1, 2013

Last Updated

March 3, 2015

Record last verified: 2015-02

Locations

US(1)