Meredith P Fort1, Lynnette M Namba2, Sarah Dutcher3, Tracy Copeland4, Neysa Bermingham5, Chris Fellenz6, Deborah Lantz7, John J Reusch8, Elizabeth A Bayliss9. 1. Research Assistant Professor in the Department of Health Systems, Management and Policy and the Centers for American Indian and Alaska Native Health at the University of Colorado Denver in Aurora. meredith.fort@ucdenver.edu. 2. Senior Community Health Specialist in the Community Benefit and Relations Department at Kaiser Permanente Colorado in Denver. lynnette.m.namba@kp.org. 3. Community Health Center Advocate and a former Senior Manager in the Quality Initiatives Division of the Colorado Community Health Network in Denver. sdutcher@kentdenver.org. 4. Project Coordinator for Community Care in the Community Benefit and Relations Department at Kaiser Permanente Colorado in Denver. tracy.s.copeland@kp.org. 5. Former Access to Care Manager in the Community Benefit and Relations Department at Kaiser Permanente Colorado in Denver. neysawb@yahoo.com. 6. Physician Lead for Safety Net Partnerships and Access to Care in the Community Benefit and Relations Department at Kaiser Permanente Colorado in Denver. christopher.j.fellenz@kp.org. 7. Clinical Services Director for the Department of Neurology and Community Patient Access for Kaiser Permanente Colorado in Denver. deborah.j.lantz@kp.org. 8. Cardiologist with the Colorado Permanente Medical Group in Denver. john.j.reusch@kp.org. 9. Clinician Investigator for the Institute for Health Research of Kaiser Permanente Colorado in Denver and a Professor of Family Medicine at the University of Colorado School of Medicine. elizabeth.bayliss@kp.org.
Abstract
OBJECTIVES: In response to limited access to specialty care in safety-net settings, an integrated delivery system and three safety-net organizations in the Denver, CO, metropolitan area launched a unique program in 2013. The program offers safety-net providers the option to electronically consult with specialists. Uninsured patients may be seen by specialists in office visits for a defined set of services. This article describes the program, identifies aspects that have worked well and areas that need improvement, and offers lessons learned. METHODS: We quantified electronic consultations (e-consults) between safety-net clinicians and specialists, and face-to-face specialist visits between May 2013 and December 2014. We reviewed and categorized all e-consults from November and December 2014. In 2015, we interviewed 21 safety-net clinicians and staff, 12 specialists, and 10 patients, and conducted a thematic analysis to determine factors facilitating and limiting optimal program use. RESULTS: In the first 20 months of the program, safety-net clinicians at 23 clinics made 602 e-consults to specialists, and 81 patients received face-to-face specialist visits. Of 204 primary care clinicians, 103 made e-consults; 65 specialists participated in the program. Aspects facilitating program use were referral case managers' involvement and the use of clear, concise questions in e-consults. Key recommendations for process improvement were to promote an understanding of the different health care contexts, support provider-to-provider communication, facilitate hand-offs between settings, and clarify program scope. CONCLUSION: Participants perceived the program as responsive to their needs, yet opportunities exist for continued uptake and expansion. Communitywide efforts to assess and address needs remain important.
OBJECTIVES: In response to limited access to specialty care in safety-net settings, an integrated delivery system and three safety-net organizations in the Denver, CO, metropolitan area launched a unique program in 2013. The program offers safety-net providers the option to electronically consult with specialists. Uninsured patients may be seen by specialists in office visits for a defined set of services. This article describes the program, identifies aspects that have worked well and areas that need improvement, and offers lessons learned. METHODS: We quantified electronic consultations (e-consults) between safety-net clinicians and specialists, and face-to-face specialist visits between May 2013 and December 2014. We reviewed and categorized all e-consults from November and December 2014. In 2015, we interviewed 21 safety-net clinicians and staff, 12 specialists, and 10 patients, and conducted a thematic analysis to determine factors facilitating and limiting optimal program use. RESULTS: In the first 20 months of the program, safety-net clinicians at 23 clinics made 602 e-consults to specialists, and 81 patients received face-to-face specialist visits. Of 204 primary care clinicians, 103 made e-consults; 65 specialists participated in the program. Aspects facilitating program use were referral case managers' involvement and the use of clear, concise questions in e-consults. Key recommendations for process improvement were to promote an understanding of the different health care contexts, support provider-to-provider communication, facilitate hand-offs between settings, and clarify program scope. CONCLUSION:Participants perceived the program as responsive to their needs, yet opportunities exist for continued uptake and expansion. Communitywide efforts to assess and address needs remain important.
Authors: Nakela L Cook; LeRoi S Hicks; A James O'Malley; Thomas Keegan; Edward Guadagnoli; Bruce E Landon Journal: Health Aff (Millwood) Date: 2007 Sep-Oct Impact factor: 6.301
Authors: Meghan M Scheibe; John B Imboden; Gabriela Schmajuk; Mary Margaretten; Jonathan D Graf; Alice H Chen; Edward H Yelin; Jinoos Yazdany Journal: Arthritis Care Res (Hoboken) Date: 2015-08 Impact factor: 4.794
Authors: Varsha G Vimalananda; Jay D Orlander; Melissa K Afable; B Graeme Fincke; Amanda K Solch; Seppo T Rinne; Eun Ji Kim; Sarah L Cutrona; Dylan D Thomas; Judith L Strymish; Steven R Simon Journal: J Am Med Inform Assoc Date: 2020-03-01 Impact factor: 4.497
Authors: Mohamed A Osman; Kara Schick-Makaroff; Stephanie Thompson; Liza Bialy; Robin Featherstone; Julia Kurzawa; Deenaz Zaidi; Ikechi Okpechi; Syed Habib; Soroush Shojai; Kailash Jindal; Branko Braam; Erin Keely; Clare Liddy; Braden Manns; Marcello Tonelli; Brenda Hemmelgarn; Scott Klarenbach; Aminu K Bello Journal: BMJ Glob Health Date: 2019-09-13