Jason H Wasfy1, Sandhya K Rao2, Neil Kalwani3, Melissa D Chittle4, Calvin A Richardson5, Kathleen M Gallen6, Eric M Isselbacher7, Alexandra B Kimball8, Timothy G Ferris2. 1. Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard, Medical School, Boston, MA; Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: jwasfy@mgh.harvard.edu. 2. Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 3. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 4. Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA. 5. Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 6. Heart Center, Massachusetts General Hospital, Boston, MA. 7. Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard, Medical School, Boston, MA; Healthcare Transformation Laboratory, Massachusetts General Hospital, Boston, MA. 8. Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Dermatology, Massachusetts General Hospital, Boston, MA.
Abstract
AIMS: Cardiac e-consults may be an effective way to deliver value-oriented outpatient cardiology care in an accountable care organization. Initial results of cardiac e-consults have demonstrated high satisfaction among both patients and referring providers, no known adverse events, and low rates of diagnostic testing. Nevertheless, differences between e-consults and traditional consults, effects of e-consults on traditional consult volume, and whether patients seek traditional consults after e-consults are unknown. METHODS AND RESULTS: We established a cardiac e-consult program on January 13, 2014. We then conducted detailed medical record reviews of all patients with e-consults to detect any adverse clinical events and detect subsequent traditional visits to cardiologists. We also performed 2 comparisons. First, we compared age, gender, and referral reason for e-consults vs traditional consults. Second, we compared changes in volume of referrals to cardiology vs other medical specialties that did not have e-consults. From January 13 to December 31, 2014, 1,642 traditional referrals and 165 e-consults were requested. The proportion of e-consults of all evaluations requested over that period was 9.1%. Gender balance was similar among traditional consults and e-consults (44.8% male for e-consults vs 45.0% for traditional consults, P = .981). E-consult patients were younger than traditional consult patients (55.3 vs 60.4 years, P < .001). After the introduction of cardiac e-consults, the increase in traditional cardiac visit requests was less than the increase in traditional visit requests for control specialties (4.5% vs 10.1%, P < .001). For e-consults with at least 6 months of follow-up, 75.6% patients did not have any type of traditional cardiology visit during the follow-up period. CONCLUSION: E-consults are an effective and safe mechanism to enhance value in outpatient cardiology care, with low rates of bounceback to traditional consults. E-consults can account for nearly one-tenth of total outpatient consultation volume at 1 year within an accountable care organization and are associated with a reduction in traditional referrals to cardiologists.
AIMS: Cardiac e-consults may be an effective way to deliver value-oriented outpatient cardiology care in an accountable care organization. Initial results of cardiac e-consults have demonstrated high satisfaction among both patients and referring providers, no known adverse events, and low rates of diagnostic testing. Nevertheless, differences between e-consults and traditional consults, effects of e-consults on traditional consult volume, and whether patients seek traditional consults after e-consults are unknown. METHODS AND RESULTS: We established a cardiac e-consult program on January 13, 2014. We then conducted detailed medical record reviews of all patients with e-consults to detect any adverse clinical events and detect subsequent traditional visits to cardiologists. We also performed 2 comparisons. First, we compared age, gender, and referral reason for e-consults vs traditional consults. Second, we compared changes in volume of referrals to cardiology vs other medical specialties that did not have e-consults. From January 13 to December 31, 2014, 1,642 traditional referrals and 165 e-consults were requested. The proportion of e-consults of all evaluations requested over that period was 9.1%. Gender balance was similar among traditional consults and e-consults (44.8% male for e-consults vs 45.0% for traditional consults, P = .981). E-consult patients were younger than traditional consult patients (55.3 vs 60.4 years, P < .001). After the introduction of cardiac e-consults, the increase in traditional cardiac visit requests was less than the increase in traditional visit requests for control specialties (4.5% vs 10.1%, P < .001). For e-consults with at least 6 months of follow-up, 75.6% patients did not have any type of traditional cardiology visit during the follow-up period. CONCLUSION: E-consults are an effective and safe mechanism to enhance value in outpatient cardiology care, with low rates of bounceback to traditional consults. E-consults can account for nearly one-tenth of total outpatient consultation volume at 1 year within an accountable care organization and are associated with a reduction in traditional referrals to cardiologists.
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