Fort Meredith P, Namba Lynnette M, Dutcher Sarah, Copeland Tracy, Bermingham Neysa, Fellenz Chris, Lantz Deborah, Reusch John J, Bayliss Elizabeth A
Research Assistant Professor in the Department of Health Systems, Management and Policy and the Centers for American Indian and Alaska Native Health at the University of Colorado Denver in Aurora.
Senior Community Health Specialist in the Community Benefit and Relations Department at Kaiser Permanente Colorado in Denver.
Perm J. 2017;21:16-022. doi: 10.7812/TPP/16-022.
In response to limited access to specialty care in safety-net settings, an integrated delivery system and three safety-net organizations in the Denver, CO, metropolitan area launched a unique program in 2013. The program offers safety-net providers the option to electronically consult with specialists. Uninsured patients may be seen by specialists in office visits for a defined set of services. This article describes the program, identifies aspects that have worked well and areas that need improvement, and offers lessons learned.
We quantified electronic consultations (e-consults) between safety-net clinicians and specialists, and face-to-face specialist visits between May 2013 and December 2014. We reviewed and categorized all e-consults from November and December 2014. In 2015, we interviewed 21 safety-net clinicians and staff, 12 specialists, and 10 patients, and conducted a thematic analysis to determine factors facilitating and limiting optimal program use.
In the first 20 months of the program, safety-net clinicians at 23 clinics made 602 e-consults to specialists, and 81 patients received face-to-face specialist visits. Of 204 primary care clinicians, 103 made e-consults; 65 specialists participated in the program. Aspects facilitating program use were referral case managers' involvement and the use of clear, concise questions in e-consults. Key recommendations for process improvement were to promote an understanding of the different health care contexts, support provider-to-provider communication, facilitate hand-offs between settings, and clarify program scope.
Participants perceived the program as responsive to their needs, yet opportunities exist for continued uptake and expansion. Communitywide efforts to assess and address needs remain important.
为应对安全网医疗机构中专科护理服务获取受限的问题，科罗拉多州丹佛市都会区的一个综合医疗服务体系及三家安全网机构于2013年推出了一项独特计划。该计划为安全网医疗机构的提供者提供了与专科医生进行电子会诊的选项。未参保患者可以在专科医生的门诊中接受特定一系列服务的诊治。本文介绍了该计划，确定了运行良好的方面和需要改进的领域，并总结了经验教训。
我们对2013年5月至2014年12月期间安全网临床医生与专科医生之间的电子会诊以及面对面的专科门诊进行了量化。我们对2014年11月和12月的所有电子会诊进行了审查和分类。2015年，我们采访了21名安全网临床医生和工作人员、12名专科医生以及10名患者，并进行了主题分析，以确定促进和限制该计划最佳使用的因素。
在该计划的前20个月中，23家诊所的安全网临床医生向专科医生进行了602次电子会诊，81名患者接受了面对面的专科门诊。在204名初级保健临床医生中，103人进行了电子会诊；65名专科医生参与了该计划。促进该计划使用的因素包括转诊病例管理人员的参与以及在电子会诊中使用清晰、简洁的问题。流程改进的关键建议是促进对不同医疗环境的理解，支持提供者之间的沟通，促进不同医疗机构之间的交接，并明确计划范围。
参与者认为该计划满足了他们的需求，但仍有继续推广和扩大的机会。全社区评估和满足需求的努力仍然很重要。
