Shared Care: Using an Electronic Consult Form to Facilitate Primary Care Provider-Specialty Care Coordination
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Corinna J Rea1, Larissa M Wenren2, Katherine D Tran2
1Division of General Pediatrics, Boston Children's Hospital, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass; Harvard Medical School, Boston, Mass.
Insights
An electronic referral system improved communication and reduced wait times for specialty care in children, though it did not change referral volumes. This innovative system enhances care coordination between primary care providers (PCPs) and specialists.
Area of Science:
- Pediatric Healthcare
- Health Informatics
- Care Coordination
Background:
- Poor care coordination between primary care providers (PCPs) and specialists negatively impacts children's health.
- Effective communication channels are crucial for optimal pediatric patient outcomes.
Purpose of the Study:
- To evaluate the impact of an electronic consultation and referral system on referral patterns and PCP-specialist communication.
- To assess the feasibility and satisfaction with a novel electronic referral system in a pediatric setting.
Main Methods:
- A pilot electronic referral and consultation system was implemented between primary care providers and neurology/gastroenterology specialists.
- Data collected included specialist response times, referral rates, wait times, and visit completion rates.
- Surveys assessed PCP and specialist satisfaction and perceived system feasibility.
Main Results:
- Specialists responded to 88% of electronic consults within 3 business days.
- Wait times for specialty appointments significantly decreased (48 to 34 days), and visit completion rates improved (58% to 70%).
- Referral volumes remained stable, but PCPs reported improved communication (89%) and enhanced patient care (92%).
Conclusions:
- Electronic referral and consultation systems are feasible and improve timely access to pediatric specialty care.
- The system enhanced PCP-specialist communication and efficiency without altering referral volumes.
- This model offers a scalable solution for improving care coordination in various healthcare settings.
Objective:
The quality of children's health is compromised by poor care coordination between primary care providers (PCPs) and specialists. Our objective was to determine how an electronic consultation and referral system impacts referral patterns and PCP-specialist communication.
Methods:
The primary care clinic at Boston Children's Hospital piloted an electronic referral and consultation system with the neurology and gastroenterology departments from April 1, 2014, to October 31, 2016. PCPs completed an electronic consult form, and if needed, specialists replied with advice or facilitated expedited appointments. Specialist response times, referral rates, wait times, and completion rates for specialty visits were tracked. PCPs and specialists also completed a survey to evaluate feasibility and satisfaction.
Results:
A total of 82 PCPs placed 510 consults during the pilot period. Specialists responded to 88% of requests within 3 business days. Eighteen percent of specialty visits were deferred and 21% were expedited. Wait times for specialty appointments to both departments significantly decreased, from 48 to 34 days (P < .001), and completion rates improved from 58% to 70% (P < .01), but referral volumes remained stable (25 per month to 23 per month; P = .29). Most PCPs said the Shared Care system facilitated better communication with specialists (89%) and enabled them to provide superior patient care (92%). Specialists reported that the system required a minimal amount of time and enabled them to educate PCPs and triage referrals.
Conclusions:
Implementation of an electronic referral and consultation system was feasible and provided timely access to specialty care, but did not affect referral volume. This system could serve as a model for other health care organizations and specialties.
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