Implementation of Outpatient Infectious Diseases E-Consults at a Safety Net Healthcare System

Area of Science:

• Infectious Diseases
• Healthcare Systems Research
• Telemedicine

Background:

• Safety net healthcare systems face high patient volumes and demand for specialty care, including infectious diseases (ID).
• Electronic ID consults (E-consults) offer an alternative to in-person referrals, reducing patient constraints and potentially increasing access to ID care in limited-resource settings.

Purpose of the Study:

• To characterize outpatient ID E-consults at a safety net healthcare system.
• To identify factors influencing the conversion of E-consults to face-to-face clinic visits.
• To develop a predictive model for face-to-face conversion.

Main Methods:

• Retrospective analysis of 725 outpatient ID E-consults from March 2018 to February 2021.
• Descriptive statistics to characterize E-consult topics and requesting providers.
• Logistic regression modeling to predict conversion to face-to-face visits.

Main Results:

• Common E-consult topics included latent tuberculosis, syphilis, and gastrointestinal infections.
• The majority of E-consults (78%) were resolved without a face-to-face ID visit.
• A predictive model achieved 80% accuracy in identifying the need for a face-to-face visit (AUC 0.72).

Conclusions:

• Outpatient ID E-consult programs are effective for timely specialist input in safety net systems.
• E-consults are utilized by various providers and successfully resolve most common ID issues without in-person visits.
• Predictive modeling can accurately forecast the necessity of face-to-face consultations, optimizing resource allocation.