Dept of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH, United States; Dept of Surgery, Wright State University, Dayton, OH, United States.
Dept of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH, United States.
Int J Med Inform. 2017 Dec;108:42-48. doi: 10.1016/j.ijmedinf.2017.09.005. Epub 2017 Sep 21.
Electronic Consultation (e-consults) can provide improved access, enhance patient and provider satisfaction, and reduce beneficiary travel expenses. We explored how e-consults were implemented across three specialty areas, diabetes (Diab), gastroenterology (GI), and neurosurgery (Neuro), at two Veterans Affairs hospitals in terms of strategies for use and time-lines.
We conducted observations and electronically shadowed patient e-consultations submitted to a specialty care service by primary care provider(s) at the two sites during a thirteen-month period. We divided the e-consult process in each specialty into three broad milestones; Request (from primary to specialty), Response (from specialty back to primary), and Follow up (from primary to patient), and recorded the flow and time in each category. An overall hierarchy of e-consults was developed to illustrate the many ways an e-consult was used. The Kolmogorov-Smirnov test was used to compare the distribution of time across specialties.
A total of 394 consults submitted between April 14, 2012 and May 2, 2013 were reviewed (Diab=152, GI=169, Neuro=73). Of the 152 diabetes specialty clinic e-consults, 35% required some sort of direct contact with the patient by the specialty clinic before a recommendation was provided. Overall, 58% of the e-consults were completed within 20days, while 68% were completed within 30days. The Response times between Diab and GI were significantly different (median=0 vs. 3days; p<0.0001) and so were Follow up times (median=0 vs. 4days; p<0.0001). All three stages were statistically different between Diab and Neuro; however, there was not enough evidence to suggest any differences between GI and Neuro.
The use of an e-consult is likely to vary based on the specialty, but the often significant variations in time may continue to hinder prompt access to care. E-consult design, implementation, documentation, training, self-learning, and monitoring should be tailored to get the most benefit out of this system.
电子咨询（e-consults）可以提供更好的获取途径，提高患者和医生的满意度，并降低受益人的旅行费用。我们探讨了在两家退伍军人事务部医院的三个专业领域（糖尿病[Diab]、胃肠病学[GI]和神经外科[Neuro]）中，电子咨询是如何在使用策略和时间线上实施的。
我们在 13 个月的时间里，对两家医院的初级保健提供者向专业护理服务提交的患者电子咨询进行了观察和电子跟踪。我们将每个专科的电子咨询过程分为三个广泛的里程碑；请求（从初级保健到专科）、回应（从专科回到初级保健）和随访（从初级保健到患者），并记录每个类别的流程和时间。制定了一个电子咨询的总体层次结构，以说明电子咨询的多种用途。使用 Kolmogorov-Smirnov 检验比较了不同专业之间的时间分布。
共审查了 2012 年 4 月 14 日至 2013 年 5 月 2 日期间提交的 394 份咨询（糖尿病 152 份，胃肠病学 169 份，神经外科 73 份）。在 152 例糖尿病专科诊所的电子咨询中，有 35%需要专科诊所与患者进行某种直接接触，然后才能提出建议。总的来说，58%的电子咨询在 20 天内完成，68%在 30 天内完成。糖尿病和胃肠病学之间的响应时间有显著差异（中位数分别为 0 天和 3 天；p<0.0001），随访时间也有显著差异（中位数分别为 0 天和 4 天；p<0.0001）。糖尿病和神经外科的三个阶段在统计学上都有显著差异；然而，胃肠病学和神经外科之间没有足够的证据表明存在差异。
电子咨询的使用可能因专业而异，但时间上的显著差异可能继续阻碍及时获得护理。电子咨询的设计、实施、记录、培训、自我学习和监测应根据系统的最大效益进行调整。
