Shared Care: Using an Electronic Consult Form to Facilitate Primary Care Provider-Specialty Care Coordination

Corinna J Rea; Larissa M Wenren; Katherine D Tran; Eric Zwemer; Daniel Mallon; Miya Bernson-Leung; Ronald C Samuels; Sara L Toomey

doi:10.1016/j.acap.2018.03.010

Shared Care: Using an Electronic Consult Form to Facilitate Primary Care Provider-Specialty Care Coordination

Acad Pediatr. 2018 Sep-Oct;18(7):797-804. doi: 10.1016/j.acap.2018.03.010. Epub 2018 Apr 3.

Authors

Corinna J Rea¹, Larissa M Wenren², Katherine D Tran², Eric Zwemer³, Daniel Mallon⁴, Miya Bernson-Leung⁵, Ronald C Samuels³, Sara L Toomey³

Affiliations

¹ Division of General Pediatrics, Boston Children's Hospital, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: corinna.rea@childrens.harvard.edu.
² Division of General Pediatrics, Boston Children's Hospital, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass.
³ Division of General Pediatrics, Boston Children's Hospital, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass; Harvard Medical School, Boston, Mass.
⁴ Harvard Medical School, Boston, Mass; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass; Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass.
⁵ Harvard Medical School, Boston, Mass; Department of Neurology, Boston Children's Hospital, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass.

PMID: 29625232
DOI: 10.1016/j.acap.2018.03.010

Abstract

Objective: The quality of children's health is compromised by poor care coordination between primary care providers (PCPs) and specialists. Our objective was to determine how an electronic consultation and referral system impacts referral patterns and PCP-specialist communication.

Methods: The primary care clinic at Boston Children's Hospital piloted an electronic referral and consultation system with the neurology and gastroenterology departments from April 1, 2014, to October 31, 2016. PCPs completed an electronic consult form, and if needed, specialists replied with advice or facilitated expedited appointments. Specialist response times, referral rates, wait times, and completion rates for specialty visits were tracked. PCPs and specialists also completed a survey to evaluate feasibility and satisfaction.

Results: A total of 82 PCPs placed 510 consults during the pilot period. Specialists responded to 88% of requests within 3 business days. Eighteen percent of specialty visits were deferred and 21% were expedited. Wait times for specialty appointments to both departments significantly decreased, from 48 to 34 days (P < .001), and completion rates improved from 58% to 70% (P < .01), but referral volumes remained stable (25 per month to 23 per month; P = .29). Most PCPs said the Shared Care system facilitated better communication with specialists (89%) and enabled them to provide superior patient care (92%). Specialists reported that the system required a minimal amount of time and enabled them to educate PCPs and triage referrals.

Conclusions: Implementation of an electronic referral and consultation system was feasible and provided timely access to specialty care, but did not affect referral volume. This system could serve as a model for other health care organizations and specialties.

Keywords: electronic consultation; electronic medical record; electronic referral; primary care; referral system; specialty care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Appointments and Schedules
Child
Child, Preschool
Continuity of Patient Care
Electronic Health Records*
Feasibility Studies
Female
Gastroenterologists
Humans
Interdisciplinary Communication*
Male
Neurologists
Pediatricians*
Pilot Projects
Referral and Consultation / organization & administration*