The adult congenital heart disease collaborative care model: Improving access with a care delivery innovation

There is a critical nationwide access gap for the care of adults with congenital heart disease (ACHD). In Hawaii, where there are only 2 ACHD cardiologists serving the broader state-wide healthcare system, at most 10% of ACHD patients receive specialty care. Our goal was to 1) design and implement a novel program structured to provide high-quality ACHD care to a large population of patients by a limited number of ACHD specialists; and 2) evaluate the preliminary impact of this program on ACHD specialty care clinic volume.

We built a novel care delivery model wherein the University of Washington AIMS Psychiatric Collaborative Care Model (CoCM) is adapted to expand the reach of ACHD specialists via team-based care coordination and integration of adult cardiologists and primary care providers. To evaluate the impact on access, we compared clinic volume during the pilot implementation phase in April - May 2026, to the volume of patients seen during 2023.

Within 5 months of implementation, the ACHD CoCM average weekly clinic volume was 19.6 patients per 0.2 FTE ACHD cardiologist, compared to the traditional care model baseline of 10.5 ACHD patients.

We launched a novel ACHD CoCM to improve access to high-quality ACHD care using carefully orchestrated care coordination and integration of primary treating providers, with preliminary data suggesting a ∼2-fold increase in specialty care clinic volume. We estimate with refinements this could ultimately expand each ACHD cardiologist's panel capacity by 3.3 times compared to a traditional care model.