安大略电子会诊（eConsult）服务：两种模式使用数据的横断面分析

The Ontario Electronic Consultation (eConsult) Service: Cross-sectional Analysis of Utilization Data for 2 Models.

作者信息

Guglani Sheena, Liddy Clare, Afkham Amir, Mitchell Rhea, Keely Erin

机构信息

C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, ON, Canada.

Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.

出版信息

JMIR Form Res. 2022 Apr 22;6(4):e32101. doi: 10.2196/32101.

DOI:10.2196/32101

PMID:35451985

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9077515/

Abstract

BACKGROUND

The Ontario electronic consultation (eConsult) service allows a primary care provider (PCP) to access specialist advice through 2 models: the direct-to-specialist (DTS) model, where PCPs select a specialist from a directory, and the Building Access to Specialists Through eConsultation (BASE)-managed specialty service, where PCPs choose a specialty group and are assigned a specialist from a qualified pool based on availability.

OBJECTIVE

The aim of this study is to examine patterns of use between the 2 models of eConsult delivery.

METHODS

We conducted a cross-sectional analysis of utilization data collected from eConsults completed between October 2018 and September 2019. Cases were grouped based on the model used for submission (ie, BASE or DTS). Each model was assessed for the number of cases over time, specialty distribution, proportion resulting in new or additional information, impact on PCPs' decisions to refer, and billing time.

RESULTS

PCPs submitted 26,121 eConsults during the study period. The monthly case volume increased by 43% over the duration of the study, primarily in the BASE model (66% compared to 6% for DTS). PCPs were able to confirm a course of action that they originally had in mind in 41.4% (6373/15,376) of BASE cases and 41.3% (3363/8136) of DTS cases and received advice for a new or additional course of action in 54.7% (8418/15,376) of BASE cases and 56.3% (4582/8136) of DTS cases. A referral was originally contemplated but avoided in 51.3% (7887/15,376) of BASE cases and 53.3% (4336/8136) of DTS cases, originally contemplated and still needed in 19.4% (2986/15,376) of BASE cases and 17.7% (1438/8136) of DTS cases, and neither originally contemplated nor needed in 21.7% (3334/15,376) of BASE cases and 21.9% (1781/8136) of DTS cases.

CONCLUSIONS

Both eConsult models had strong uptake. Use patterns varied between models, with the majority of growth occurring under BASE, but survey responses showed that both models provided similar outcomes in terms of new information offered and impact on decision to refer.

摘要

背景

安大略省电子会诊（eConsult）服务使初级保健提供者（PCP）能够通过两种模式获取专科医生的建议：直接联系专科医生（DTS）模式，即PCP从名录中选择专科医生；以及通过电子会诊建立专科医生通道（BASE）管理的专科服务模式，即PCP选择一个专科组，然后根据可用性从合格的医生库中分配一名专科医生。

目的

本研究的目的是研究两种电子会诊提供模式的使用模式。

方法

我们对2018年10月至2019年9月期间完成的电子会诊收集的利用数据进行了横断面分析。病例根据提交所用的模式（即BASE或DTS）进行分组。对每种模式的病例数量随时间的变化、专科分布、产生新信息或额外信息的比例、对PCP转诊决定的影响以及计费时间进行了评估。

结果

在研究期间，PCP提交了26121次电子会诊。在研究期间，每月病例数增加了43%，主要是在BASE模式下（66%，而DTS模式为6%）。在41.4%（6373/15376）的BASE病例和41.3%（3363/8136）的DTS病例中，PCP能够确认他们最初心中所想的行动方案；在54.7%（8418/15376）的BASE病例和56.3%（4582/8136）的DTS病例中，PCP收到了关于新的或额外行动方案的建议。在51.3%（7887/15376）的BASE病例和53.3%（4336/8136）的DTS病例中，最初考虑过转诊但避免了；在19.4%（2986/15376）的BASE病例和17.7%（1438/8136）的DTS病例中，最初考虑过且仍然需要转诊；在21.7%（3334/15376）的BASE病例和21.9%（1781/8136）的DTS病例中，既未最初考虑过也不需要转诊。