Grace L Su1,2, Lisa Glass1,2, Elliot B Tapper1,2, Tony Van3, Akbar K Waljee1,2,3,4, Anne E Sales3,5. 1. Medicine Service, VA Ann Arbor Healthcare System, Ann Harbor, Michigan. 2. University of Michigan Medical School, Ann Arbor, Michigan. 3. VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan. 4. Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, Michigan. 5. Department of Learning Health Science, University of Michigan, Ann Arbor, Michigan.
Abstract
Access to specialty care has been associated with improved survival in patients with liver disease but universal access is not always feasible. Methods of care delivery using virtual modalities including the SCAN-ECHO (Specialty Access Network-Extension of Community Healthcare Outcome) program were implemented by the Veterans Health Administration (VHA) to address this need but limited data are available on patient outcomes. We sought to evaluate the efficacy of a SCAN-ECHO visit within the context of a regional cohort of patients with liver disease in the VHA (n = 62,237) following implementation in the Ann Arbor SCAN-ECHO Liver Clinic from June 1, 2011, to March 31, 2015. The effect of a SCAN-ECHO visit on all-cause mortality was compared with patients with no liver clinic visit. To adjust for the differences among patients who had a SCAN-ECHO visit versus those with no visit, propensity score matching was performed on condition factors that affect the likelihood of a SCAN-ECHO visit: demographics, geographic location, liver disease diagnosis, severity, and comorbidities. During the study period, 513 patients who had a liver SCAN-ECHO visit were found within the cohort. Patients who had completed a virtual SCAN-ECHO visit were more likely younger, rural, with more significant liver disease, and evidence for cirrhosis. Propensity-adjusted mortality rates using the Cox Proportional Hazard Model showed that a SCAN-ECHO visit was associated with a hazard ratio of 0.54 (95% confidence interval 0.36-0.81, P = 0.003) compared with no visit. Conclusion: Improved survival in patients using SCAN-ECHO suggests that this approach may be an effective method to improve access for selected patients with liver disease, particularly in rural and underserved populations where access to specialty care is limited. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.
Access to specialty care has been associated with improved survival in patients with liver disease but universal access is not always feasible. Methods of care delivery using virtual modalities including the SCAN-ECHO (Specialty Access Network-Extension of Community Healthcare Outcome) program were implemented by the Veterans Health Administration (VHA) to address this need but limited data are available on patient outcomes. We sought to evaluate the efficacy of a SCAN-ECHO visit within the context of a regional cohort of patients with liver disease in the VHA (n = 62,237) following implementation in the Ann Arbor SCAN-ECHO Liver Clinic from June 1, 2011, to March 31, 2015. The effect of a SCAN-ECHO visit on all-cause mortality was compared with patients with no liver clinic visit. To adjust for the differences among patients who had a SCAN-ECHO visit versus those with no visit, propensity score matching was performed on condition factors that affect the likelihood of a SCAN-ECHO visit: demographics, geographic location, liver disease diagnosis, severity, and comorbidities. During the study period, 513 patients who had a liver SCAN-ECHO visit were found within the cohort. Patients who had completed a virtual SCAN-ECHO visit were more likely younger, rural, with more significant liver disease, and evidence for cirrhosis. Propensity-adjusted mortality rates using the Cox Proportional Hazard Model showed that a SCAN-ECHO visit was associated with a hazard ratio of 0.54 (95% confidence interval 0.36-0.81, P = 0.003) compared with no visit. Conclusion: Improved survival in patients using SCAN-ECHO suggests that this approach may be an effective method to improve access for selected patients with liver disease, particularly in rural and underserved populations where access to specialty care is limited. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.
Authors: Yolanda Rodriguez Villalvazo; Jennifer S McDanel; Lauren A Beste; Antonio J Sanchez; Mary Vaughan-Sarrazin; David A Katz Journal: Health Serv Res Date: 2019-11-25 Impact factor: 3.402
Authors: Marina Serper; David E Kaplan; Justine Shults; Peter P Reese; Lauren A Beste; Tamar H Taddei; Rachel M Werner Journal: Hepatology Date: 2019-06-26 Impact factor: 17.425
Authors: S Hunter Dunn; Shari S Rogal; Marissa M Maier; Maggie Chartier; Timothy R Morgan; Lauren A Beste Journal: Dig Dis Sci Date: 2019-08-20 Impact factor: 3.199