Implementation and Evaluation of the Safety Net Specialty Care Program in the Denver Metropolitan Area

Perm J. 2017:21:16-022. doi: 10.7812/TPP/16-022.

Abstract

Objectives: In response to limited access to specialty care in safety-net settings, an integrated delivery system and three safety-net organizations in the Denver, CO, metropolitan area launched a unique program in 2013. The program offers safety-net providers the option to electronically consult with specialists. Uninsured patients may be seen by specialists in office visits for a defined set of services. This article describes the program, identifies aspects that have worked well and areas that need improvement, and offers lessons learned.

Methods: We quantified electronic consultations (e-consults) between safety-net clinicians and specialists, and face-to-face specialist visits between May 2013 and December 2014. We reviewed and categorized all e-consults from November and December 2014. In 2015, we interviewed 21 safety-net clinicians and staff, 12 specialists, and 10 patients, and conducted a thematic analysis to determine factors facilitating and limiting optimal program use.

Results: In the first 20 months of the program, safety-net clinicians at 23 clinics made 602 e-consults to specialists, and 81 patients received face-to-face specialist visits. Of 204 primary care clinicians, 103 made e-consults; 65 specialists participated in the program. Aspects facilitating program use were referral case managers' involvement and the use of clear, concise questions in e-consults. Key recommendations for process improvement were to promote an understanding of the different health care contexts, support provider-to-provider communication, facilitate hand-offs between settings, and clarify program scope.

Conclusion: Participants perceived the program as responsive to their needs, yet opportunities exist for continued uptake and expansion. Communitywide efforts to assess and address needs remain important.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Case Management
  • Colorado
  • Communication
  • Comprehensive Health Care
  • Electronics
  • Female
  • Health Services Accessibility*
  • Health Services*
  • Humans
  • Male
  • Medically Uninsured*
  • Middle Aged
  • Office Visits
  • Patient Satisfaction
  • Physicians
  • Program Evaluation
  • Referral and Consultation*
  • Safety-net Providers*
  • Specialization*
  • Telemedicine*