Asynchronous vascular consultation via electronic methods: A feasibility pilot
Asynchronous vascular consultation via electronic methods: A feasibility pilot
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DOI：
10.1177/1358863x15601734
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发表时间：
2015-12-01
影响因子：
3.5
通讯作者：
Wasfy, Jason H.
中科院分区：
文献类型：
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作者：
Chittle, Melissa D.;Rao, Sandhya K.;Wasfy, Jason H.
慢性病的管理通常需要多学科的临床努力和专科护理。随着责任医疗组织 (ACO) 的出现，医疗保健系统被激励去评估通才和专家之间的信息交换方法，以便在保持质量的同时提供价值。我们的目标是评估大型三级学术医疗中心血管护理中的异步电子咨询的患者和转诊提供者的满意度和结果。通过电子转诊管理系统向转诊提供者提供血管“电子咨询”选项。我们进行了图表审查以了解下游影响，并对患者和转诊提供者进行了调查以评估满意度。从2014年3月24日至2015年3月1日，共完成了54次电子咨询。 49/54 (90.7%) 的电子咨询中提出了额外的测试和建议，包括带反流测试的下肢静脉双重超声检查、颈动脉双重超声检查、计算机断层扫描、磁共振成像、非侵入性生理学动脉研究、实验室检查、药物、压力袜和序贯淋巴水肿压力治疗。在 40/49 (81.6%) 的电子咨询中，推荐提供商遵守了建议。共有 17/54 (31.5%) 名患者接受了调查，患者满意度中位数为 13.7/15 (91.3%) (SD +/- 6.4)。该计划与推荐提供者的高满意度相关，87.0% 的人认为电子咨询非常有帮助，80.0% 的人表示它避免了传统访问的需要。我们的经验表明，电子咨询是为某些患者提供血管护理的有效方式，并且与患者和提供者的高满意度相关。因此，电子咨询可能是 ACO 内为血管患者提供护理的有效方法。
Management of chronic disease often requires multidisciplinary clinical efforts and specialist care. With the emergence of Accountable Care Organizations (ACOs), health care systems are incentivized to evaluate methods of information exchange between generalists and specialists in order to provide value while preserving quality. Our objective was to evaluate patient and referring provider satisfaction and outcomes of asynchronous electronic consultations in vascular care in a large tertiary academic medical center. Referring providers were offered a vascular 'e-consult' option through an electronic referral management system. We conducted chart review to understand the downstream effects and surveyed patients and referring providers to assess satisfaction. From 24 March 2014 to 1 March 2015, 54 e-consults were completed. Additional testing and recommendations were made in 49/54 (90.7%) e-consults, including lower-extremity venous duplex ultrasonography with reflux testing, duplex ultrasonography of the carotid artery, computed tomography, magnetic resonance imaging, non-invasive physiology arterial studies, laboratory tests, medications, compression stockings, and sequential lymphedema compression therapy. Referring providers were compliant with recommendations in 40/49 (81.6%) of e-consults. A total of 17/54 (31.5%) patients were surveyed with a median patient satisfaction score of 13.7/15 (91.3%) (SD +/- 6.4). The program was associated with high referring provider satisfaction, with 87.0% finding the e-consult very helpful and 80.0% stating it averted the need for a traditional visit. Our experience suggests that e-consults are an effective way to provide vascular care in some patients and are associated with high patient and provider satisfaction. E-consults may therefore be an efficient method of care delivery for vascular patients within an ACO.