Improving Access to Rheumatology Care: Evaluation of a Rheumatology Electronic Consultation Program

Specialty care access remains a significant challenge, particularly for patients in rural and underserved areas. This study evaluates the implementation and impact of an electronic consultation (eConsult) program aimed at improving access to rheumatology care within the University of Colorado Hospital network.

This mixed methods evaluation of a rheumatology eConsult program used electronic health record and Medicaid claims data to describe patient, provider, and referral characteristics; care process and utilization outcomes; and interviews to gain provider insights about the program.

The analysis included 10,433 traditional referrals and 670 internal and external eConsults placed between April 2018 and June 2022. Most internal eConsults (445 of 595, 75%) were completed electronically without the need to convert to an in-person consultation, and 73% (325 of 445) were completed within three days. The eConsults that were converted to traditional face-to-face referrals had a higher 180-day completion rate (36%) compared to traditional referrals (19%, P < 0.001). Overall, eConsults and traditional referrals had comparable rates of pharmacotherapy initiation for referrals related to suspected rheumatoid arthritis (57.1% vs 31.4%, P = 0.082). Most eConsults came from primary care providers internal to the network (596 of 670, 89%). Interviews with team members highlighted successes such as improved efficiency and reduced patient travel burdens, while also identifying challenges, notably the need for increased provider familiarity and usage of the eConsult platform.

Overall, the eConsult program represents a promising strategy to enhance specialty care delivery, particularly for underserved and distant populations, though ongoing education and system integration efforts are crucial for maximizing its impact.