Leveraging an electronic referral system to build a medical neighborhood

Delphine S Tuot; Elizabeth J Murphy; Charles E McCulloch; Kiren Leeds; Evelyn Chan; Alice Hm Chen

doi:10.1016/j.hjdsi.2015.04.001

Leveraging an electronic referral system to build a medical neighborhood

Healthc (Amst). 2015 Dec;3(4):202-8. doi: 10.1016/j.hjdsi.2015.04.001. Epub 2015 May 2.

Authors

Delphine S Tuot¹, Elizabeth J Murphy², Charles E McCulloch³, Kiren Leeds⁴, Evelyn Chan⁵, Alice Hm Chen⁶

Affiliations

¹ Division of Nephrology at San Francisco General Hospital, University of California, Box 1341, San Francisco, USA; Center for Innovation in Access and Quality, San Francisco General Hospital, Box 1364, San Francisco, USA. Electronic address: Delphine.tuot@ucsf.edu.
² Division of Endocrinology at San Francisco General Hospital, University of California, Box 0862, San Francisco, USA; Center for Innovation in Access and Quality, San Francisco General Hospital, Box 1364, San Francisco, USA. Electronic address: emurphy@medsfgh.ucsf.edu.
³ Department of Epidemiology and Biostatistics, University of California, Box 0560, San Francisco, USA. Electronic address: Charles.McCulloch@ucsf.edu.
⁴ Center for Innovation in Access and Quality, San Francisco General Hospital, Box 1364, San Francisco, USA. Electronic address: leedsk@medsfgh.ucsf.edu.
⁵ Center for Innovation in Access and Quality, San Francisco General Hospital, Box 1364, San Francisco, USA. Electronic address: Evelyn.chen@ucsf.edu.
⁶ Division of General Internal Medicine at San Francisco General Hospital, University of California, Box 1364, San Francisco, USA; Center for Innovation in Access and Quality, San Francisco General Hospital, Box 1364, San Francisco, USA. Electronic address: Achen@medsfgh.ucsf.edu.

PMID: 26699344
DOI: 10.1016/j.hjdsi.2015.04.001

Abstract

Background: Electronic referral and consultation systems are gaining popularity, but their contribution to the patient centered medical home-neighborhood framework of coordinated care delivery is not clear. We examined how specialists leverage an electronic referral and consultation system to deliver specialty care, identified determinants of high-quality electronic specialist communication and measured the impact of feedback to specialists on communication quality.

Methods: Referral patterns were identified for 19 specialties using eReferral in the San Francisco public health care delivery system. Primary care provider (PCP) ratings of the quality (helpfulness and educational value) of consultative communication were measured. Using logistic regression, we identified determinants of high-quality specialist communication during pre-consultative exchange or virtual co-management. Predictors included: specialty and reviewer type, referral volume, percent of referrals never scheduled and time spent by reviewers on eReferral. A pre-post analysis examined the impact of feedback on communication quality.

Results: The percentage of referrals immediately scheduled (27.2-82.8%) and never scheduled (7.7-59.3%) varied by specialty, with medical reviewers (vs. surgical and women׳s health) and physician reviewers (vs. nurse practitioners) scheduling fewer referrals immediately (p<0.001). Prevalence of high-quality communication was 71%, impacted by referral volume (adjusted odds ratio=0.78, 95%CI 0.68-0.88 for each additional 1000 referrals/year) and time spent per referral (1.18, 1.04-1.35 for each additional 3min).

Conclusions: Specialists can use electronic referral and consultation systems to enhance specialty care delivery with consultative communication that is highly rated by PCPs.

Implications: These data can inform the structure and functionality of future electronic consultation systems to maximize care coordination.

Level of evidence: III.

Keywords: Electronic consultation; Medical neighborhood; Primary–specialty interface.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Communication
Electronic Health Records
Female
Humans
Medicine
Practice Patterns, Physicians'
Referral and Consultation* / trends
San Francisco

Abstract

Publication types

MeSH terms

Grants and funding