Young Nathan P, Burkholder David B, Philpot Lindsey M, McKie Paul M, Ebbert Jon O
Department of Neurology (NPY, DBB); Division of Primary Care Internal Medicine (JOE), Department of Medicine; Division of Cardiovascular Medicine (PMM), Department of Medicine; and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (LMP, JOE), Mayo Clinic, Rochester, MN.
Neurol Clin Pract. 2020 Oct;10(5):388-395. doi: 10.1212/CPJ.0000000000000754.
Synchronous collaboration as defined by a simultaneous encounter between primary care providers (PCPs), patients, and neurologists may improve access to neurologic expertise, care value, and satisfaction of PCPs and patients. We examined a series of synchronous collaborations and report outcomes, PCP satisfaction, downstream utilization, and illustrative case examples.
Within an outpatient collaborative primary care-neurology care model, we implemented synchronous video consultations from a central hub to satellite clinics while increasing availability of synchronous telephone and face-to-face collaboration. PCP experience was assessed by a postcollaboration survey. Individual cases were summarized. Clinical and utilization outcomes were assessed by a neurologist immediately after and by follow-up chart review.
A total of 58 total synchronous collaborations were performed: 30 by telephone (52%), 18 face to face (31%), and 10 by video (17%) over 27 clinic half-days. The most frequent outcomes as assessed by the neurologist were reassurance of the PCP (23/58; 40%) and patient (22/59; 38%), and the neurologist changed the treatment plan (23/58; 40%). A subsequent face-to-face consultation was completed in 15% (6/58) of patients initially assessed by telephone or video. Test utilization was avoided in 40% (23/58). Unintended utilization occurred 9% (5/58). Most PCPs were very satisfied with the ease of access, quality of care, and reported high likelihood of subsequent use. PCPs perceived similar or less time spent during synchronous vs asynchronous collaboration and neurologist usually altered the testing (87.8%) and treatment plan (95.2%).
Synchronous collaboration between neurologists and PCPs may improve timely access to neurologic expertise, downstream utilization, and PCP satisfaction.
基层医疗服务提供者（PCP）、患者和神经科医生同时会面所定义的同步协作，可能会改善获得神经科专业知识的机会、医疗价值以及PCP和患者的满意度。我们研究了一系列同步协作，并报告了结果、PCP满意度、下游医疗利用情况以及典型病例示例。
在门诊协作式基层医疗 - 神经科护理模式中，我们从中心枢纽向卫星诊所开展同步视频会诊，同时增加同步电话和面对面协作的可用性。通过协作后的调查评估PCP的体验。总结个别病例。神经科医生在会诊后立即以及通过后续病历审查评估临床和医疗利用结果。
在27个半天的诊所时间内，共进行了58次同步协作：30次通过电话（52%），18次面对面（31%），10次通过视频（17%）。神经科医生评估的最常见结果是让PCP放心（23/58；40%）和让患者放心（22/59；38%），并且神经科医生更改了治疗方案（23/58；40%）。最初通过电话或视频评估的患者中有15%（6/58）完成了后续的面对面会诊。40%（23/58）的患者避免了不必要的检查。意外的医疗利用发生了9%（5/58）。大多数PCP对就医便利性、医疗质量非常满意，并表示后续很可能会再次使用。PCP认为同步协作与异步协作相比花费的时间相似或更少，并且神经科医生通常会更改检查（87.8%）和治疗方案（95.2%）。
神经科医生和PCP之间的同步协作可能会改善及时获得神经科专业知识的机会、下游医疗利用情况以及PCP的满意度。
