Embed Size (px)
Citation preview
Forging Collaboration and Improving Access to Geriatrics with eConsult: A Workshop for Clinicians who are “All Alone”
Dr. Clare LiddyAssociate Professor and Clinical Investigator, C.T. Lamont Primary Health Care Research Centre, Dept. of Family Medicine, University of Ottawa
April 20, 2018
The eConsult TeamA collaboration between:• The Champlain Local Health Integration Network• The Ottawa Hospital• Bruyère Research Institute• Winchester District Memorial
Program Funding• Champlain Local Health Integration Network• Ontario Ministry of Health and Long‐term Care
Current Research Funding• Canadian Institutes of Health Research• Bruyère Research Institute‐ CLRI• Canadian Foundation for Healthcare Improvement• Canada Health Infoway
Clare LiddyPrimary Care Lead
Erin KeelySpecialist Lead
Amir AfkhamEngagement & Implementation Lead
[email protected] [email protected] [email protected]‐562‐6262, Ext. 2928 613‐738‐8400, Ext. 81941 613‐747‐3235
Faculty/Presenter Disclosure
•Faculty: Clare Liddy
•Relationships with commercial interests:– Grants/Research Support: None– Speakers Bureau/Honoraria: None– Consulting Fees: None– Other: None
Disclosure of Commercial Support
•This program has received no financial or in-kind support from commercial interests
•Potential for conflict(s) of interest:– Dr. Clare Liddy has no conflicts of interest to declare, real or perceived
Where it all started:Champlain region• Population of 1.2 million
• One major urban referral center (Ottawa, ON)
• Surrounding rural communities up to 2 hours away by car
• Demographics/health outcomes similar to the rest of Ontario/Canada
• Long, cold winters (average winter low -11.2°C)
The problem: poor access
“I have been waiting a long time to get my appointment with the specialist”
“Takes a long time to have an non-urgent patient seen in Endocrinology”
“I refer and then wait and do not even know if the fax was received…”
“I am frustrated by my wait list. I can’t ever seem to catch up…”
hat is an eConsultation?
Asynchronous, electronic communication between providers
Patient-specific question directed to a specialist
May result in patient not needing a face-to-face visit with a specialist
ow does eConsult work?
PCP logs onto secure webpage
ompletes simple form to submit to a “specialty”
Assigned to an appropriate specialist (availability/rotation))
esponse received within 7 days; back and forth communication can occur between PCP and
specialist
PCP closes eConsult and completes survey
ase example - Dermatology
1 PCP asks : “Elderly patient with w lip lesions X 6months and
easing in size. Approx 3-4mm, oth. Non tender . Your thoughts ifferential and urgency of biopsy appreciated.
2 Specialist “ the most likely nosis for this blue-black papule he left upper lip is venous lake. I ot have the benefit of palpating esions. A venous lake is soft, c and has no enduration…”
Detailed question with image sent to Dermatology
Response within 1 day with educational tips about identifying type of lesion
se example
onsult dialogue10 21:36 PCP asks an additional
stions. “After re-examination the n is quite soft. The patient would t removed for cosmetic reasons. ld you recommend referral to
matology or plastic surgery given tion?”
10 22:00 Specialist response ous lakes are best treated by rtherapy. I suggest Dr X at XX clinic he has the appropriate laser for this. ourse there is a fee since not red by OHIP.”
Impact of eConsult
Opportunity to ask additional question
Educational opportunity and efficient redirect to most appropriate specialist for this patient
0
5000
10000
15000
20000
25000
30000
35000
2011 2012 2013 2014 2015 2016 2017
33,327 cases completed*
1,355 PCPs (1,160 MDs and 195 NPs) from 476 clinics in 109 towns/cities have joined the service
109 specialty groups available
vidence base: population reach
Cases Completed PCP Engagement
Numb
er of
PCP
s Enr
olled
0
200
400
600
800
1000
1200
1400
2011 2012 2013 2014 2015 2016 2017
Current specialty services (n=109)dictions Assessment/atment Servicesdictions – Opioids and otherbstancesergy and Clinical Immunologyesthesiology (Adult) *ck and Neck (Spine) Care *riatric Care
Medicalurgical
Dietitianncer Geneticsncer Screeningncer Survivorshiprdiology *amplain CCACiropodynical Pharmacy *ncussion – Rehabilitationnservative Kidney Management Clinicrmatology *air loss
abetes Educationdocrinology *
OsteoporosisT & Head/Neck Surgerystroenterologyneticsneral Surgeryriatrics * Medications (Deprescribing)
Mi d (D ti D li i )
Pain Medicine *• Hip Pain (under 50)
Pain and Opioid Addictions/ Addictions – Opioids
Palliative Care * Psychiatry * Psychiatry – On Track First
Psychosis Episode Psychiatry - Perinatal Public Health – Ottawa Radiation-Radiotherapy Injury Refugee and Immigrant Health
(Adult) Radiology:
• Abdominal• Breast• Musculoskeletal• Neuro Radiology• Thoracic
Refugee and Immigrant Health(Adult)
Respirology Rheumatology * Sexual Assault/Domestic Violence Spinal Surgery Sports Medicine Thoracic Surgery Thrombosis Transgender Care Urology * Vascular Surgery Wound Care
GeriMedrisk Gynecology Hematology Hemostasis
HIV• Specialists• Pharmacist• Psychologist• Social Worker
Infectious Diseases * ID - Viral Hepatitis Internal Medicine * Musculoskeletal Rehab *
Nephrology * Neurology Migraine Parkinson Patient Care
Coordination Parkinsons and Movement
Disorders Epilepsy Dementia and Cognitive
Neurology Multiple Sclerosis
Neurosurgery OBS/GYN Vulvo-Vaginal Disease Menopause/Perimenopause Urogynecology
Obstetrics Ophthalmology
edications, Mind , Mobility and more
eriatrics * Medications (Deprescribing) Mind (Dementia, Delirium) Mobility (Falls and Near Falls GeriMed Risk
Chronic pain Psychiatry Wound Care Neurology Parkinson’s Care Coordination Dementia and Cognitive neurology
he Evidence Base for Champlain BASETM
Better Population Health Improved Patient Experience
Lower Costs Improved Provider Experience
Exploring Policy/Implementation Issues
• eConsult cuts response times from months to days (0.9 days median)
• Two‐thirds of cases did not require a face‐to‐face specialist referral
• Exploration of specific populations (e.g. chronic pain patients, pharmacists) reveal high value of service
• eConsult responds to previously articulated patient dissatisfaction with wait times
• Interviews with patients reveal high satisfaction with eConsult’s impact on access, care quality, and continuity of care
• Across specialty groups, the service cost a weighted average of $47.35/case versus $133.60/case for traditional referrals
• Costs drop dramatically after the start‐up period, reaching ~$6.45/case by year 3
• Further savings that account for societal costs are estimated at ~$11 per eConsult
• PCPs rank eConsult as high/very high value in over 90% of cases
• 94% of specialists report eConsult improves communication with PCPs
• eConsult provides a powerful teaching tool for PCPs
• eConsult services remain relatively uncommon in Canada• Implementation of a successful service requires adherence to key steps• A number of legal and policy challenges must be addressed to support the full and
effective implementation of eConsult services
tient perspectives of eConsult
She took photos of both my hands [and] sent them through the eConsult and within 24 hours I was back in the office [with a prescription].
t was really, really helpful and I was so happy that it was available. […]
t just kind of gives me a bit of peace of mindproved Patient experience through better access, are coordination
pact of eConsult on access• Specialists responded to eConsults in a median of 0.9 days*
(Improved access)
• 67% of cases did not require a face-to-face specialist visit (efficient, coordinated care)
• In 4% of cases, eConsult prompted a medical referral (patient safety)
ducational value of eConsults
This was an excellent educational opportunity for me. I knew I didn't need to worry about this case but I got extra education about when I should worry and what course of action to take in these situations. I have shared this learning opportunity with my residents as well."
mple Comments for Geriatrics Specialtiesks for the article from AHRQ very helpful!”
t additional information and alternate routes to pursue ”
, succinct answer helped!”
helpful, detailed information to assist me in linking a complex geriatric patient to the sary resources in her community. Thank you!”
offered superb advice - especially in regards to communication with this patient's family. you!”
ks X for your thorough answer. Very helpful.”
k you, Dr. X! I have been slow to close this, but the patient is now awaiting reassessment riatrics. I really appreciate the advice, and I will bear the options in mind for future cases. ”
ks Dr X for your comprehensive answer. Very helpful..”
k you for the added time and effort to answer extra questions.”
Consult and Geriatric Patients
A 2016 study found 21.3% of eConsult cases were submitted for patients over 65 years of age1
Results were comparable to overall population:Median response time of 0.8 daysHigh/very high value in 94% of casesReferral required in only 28% of cases
Clear evidence of value for elderly patients, many of who face mobility challenges
onsult for LTC Patients ( early results)
61 cases submitted to 15 specialty groups*5 active PCPs from LTC using eConsult
pact of eConsult - LTC
• In 62% of cases, PCPs in LTC homes received new advice for a new or additional course of action
• 68% of eConsults resolved without a face-to-face visit
otential Cost Savings in LTCPotential cost savings through avoided transfers and specialist referrals is tremendous
Avoiding unnecessary specialist visits:• Alleviates staff from the process of securing
transportation for residents
• Prevents residents from having to ask family members to accompany them to specialist visits
pread and scale-up across Canada
Newfoundland and Labrador• Provincial focus• Uses BASETM platform• Direct replication
Nunavut• Access to Champlain BASETMspecialists for remote PCPs
Quebec• BASE model of Quebec platform
• Launched July 2017l l
Ontario (SEAMO)• Pilot launched in new region (SE LHIN)• Different platform, BASETM workflow• Provincial program
nitobases BASETM platformirect replicationaunch Fall 2017
Consult is spreading to your region!
Ontario- recently launched Ontario eConsultCentre of Excellence ( Dr Liddy and Dr Keely)Quebec, Manitoba & Newfoundland have mplemented BASE eConsultAlberta- eReferral and eConsult ( advice request)New Brunswick- eConsult funded- launch 2018BC- eConsult and RACE systems availableSaskatchewan eConsult readiness underway in 2018
Phase 1Outaouais1 GMF‐U 15 spécialistes25 FSP24 résidentsJuillet 2017
Phase 2Abitibi‐Témiscamingue2 GMF, 1 GMF‐U6 spécialistes33 FSP6 résidentsFévrier 2018Intégration au CRDS
Phase 3Mauricie et Centre‐du‐Québec3 GMF2 spécialistes 47 FSPAvril 2018Intégration au CRDS
For more information, check out our eBook
Available in iBook (for Mac) and pdf (for PC) fromwww.ChamplainBASEeConsult.com
