Reduced Cost Of Specialty Care Using Electronic Consultations For Medicaid Patients

Anderson, Daren; Villagra, Victor G.; Coman, Emil; Ahmed, Tamim; Porto, Anthony F.; Jepeal, Nicole; Maci, Giuseppe; Teevan, Bridget

doi:10.1377/hlthaff.2018.05124

Cited by 49 publications

(30 citation statements)

References 9 publications

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“…In in the same health care system, a separate observational study reported average costs per month that were $82 lower per patient across 4 medical and surgical specialties after the introduction of e-consults. 50 While specific dollar figures are difficult to interpret and generalize to other health care systems, these 3 studies are at least consistent with the hypothesis that e-consult programs are generally cost-saving to payers.…”

Section: Costsmentioning

confidence: 63%

“…More than half of the included studies were from 1 of 2 settings: 26 from the Champlain BASE program and 13 from VA settings. 7,[37][38][39][40][41][42][43][44][45][46][47][48] Of the remaining 24 studies, there were 12 from community health centers or large public health care systems, 43,[49][50][51][52][53][54][55][56][57][58][59] 8 from academic medical centers, [60][61][62][63][64][65][66][67] 2 from a nongovernmental humanitarian organization, 68, 69 1 from a not-for-profit integrated health care delivery system, 70 and 1 from a private company providing e-consult services. 71 Most studies were observational in design and lacked a control group.…”

Section: Methodsmentioning

confidence: 99%

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Electronic consultations (E-consults) and their outcomes: a systematic review

Vimalananda

Orlander

Afable

et al. 2019

Journal of the American Medical Informatics Association

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Objective Electronic consultations (e-consults) are clinician-to-clinician communications that may obviate face-to-face specialist visits. E-consult programs have spread within the US and internationally despite limited data on outcomes. We conducted a systematic review of the recent peer-reviewed literature on the effect of e-consults on access, cost, quality, and patient and clinician experience and identified the gaps in existing research on these outcomes. Materials and Methods We searched 4 databases for empirical studies published between 1/1/2015 and 2/28/2019 that reported on one or more outcomes of interest. Two investigators reviewed titles and abstracts. One investigator abstracted information from each relevant article, and another confirmed the abstraction. We applied the GRADE criteria for the strength of evidence for each outcome. Results We found only modest empirical evidence for effectiveness of e-consults on important outcomes. Most studies are observational and within a single health care system, and comprehensive assessments are lacking. For those outcomes that have been reported, findings are generally positive, with mixed results for clinician experience. These findings reassure but also raise concern for publication bias. Conclusion Despite stakeholder enthusiasm and encouraging results in the literature to date, more rigorous study designs applied across all outcomes are needed. Policy makers need to know what benefits may be expected in what contexts, so they can define appropriate measures of success and determine how to achieve them.

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Section: Costsmentioning

confidence: 63%

Section: Methodsmentioning

confidence: 99%

Electronic consultations (E-consults) and their outcomes: a systematic review

Vimalananda

Orlander

Afable

et al. 2019

Journal of the American Medical Informatics Association

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“…Intervention outcome data were analysed using Stata 16 (StataCorp, TX, USA) [52] by an independent statistician who had not been involved in intervention delivery or data collection and was blind to group allocation. We tested the normality of the pre and post outcomes, and all three outcomes were skewed and kurtotic (except baseline job performance), with an excess of higher values; however, instead of transforming them, we tested whether analyses specifically modelling the non-normality would yield different results than those assuming normality, using the Mplus skewt recently implemented modelling option (see an example with software code posted in Anderson and colleagues [53]). The skewt option of estimation simply adds two parameters (besides mean and variance) for all variables analysed, and hence properly corrects estimates for non-normality.…”

Section: Methodsmentioning

confidence: 99%

Move-It: A Cluster-Randomised Digital Worksite Exercise Intervention in China: Outcome and Process Evaluation

Blake

Lai

Coman

et al. 2019

IJERPH

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We evaluate the outcomes and processes of a video and web-based worksite exercise intervention for sedentary office workers in China, in a 2-arm cluster-randomised wait-list control trial (n = 282: intervention (INT) n = 196 and wait-list control (WLC) n = 86). Eligible clusters were two sites of a major organisation in China randomly allocated to each group (INT: Guangzhou; WLC: Beijing); eligible participants were site employees (n = 690). A theoretically informed digital workplace intervention (Move-It) involving a 10 min Qigong exercise session (video demonstration via website) was delivered twice a day at set break times during the working day for 12 consecutive weeks. Individual-level outcomes were assessed. Participants’ physical activity increased significantly from baseline to post-intervention similarly in both the intervention and the control group. There was a significantly smaller increase in weekday sitting hours in intervention than controls (by 4.66 h/week), and work performance increased only in the control group. Process evaluation (including six focus groups) was conducted using the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework. The intervention had wide reach and was successfully marketed to all employees with good uptake. The participatory approach increased perceived organisational support and enhanced adoption. The intervention was implemented broadly as planned. Qigong worksite exercise intervention can be successfully delivered to sedentary office workers in China using video and web-based platforms. It may increase physical activity and does not adversely affect perceived work performance. The study highlights the complexity of conducting health promotion research in real-world organisational settings.

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“…1 E-consults are less formal than an in-person provider/patient consultation but more formal than a "curbside" consult between health care providers. 1 Advantages of econsults include improved patient access to specialist care, potential cost savings, 2 and convenience for both health care providers and patients. 1 The utility and feasibility of e-consults has been demonstrated across multiple specialties, including cardiology, 3,4 gastroenterology, 5 endocrinology, 6 infectious disease, 7 nephrology, 8 and dermatology.…”

mentioning

confidence: 99%

Inpatient Electronic Consultations (E-consults) in Allergy/Immunology

Mustafa

Staicu

Yang

et al. 2020

The Journal of Allergy and Clinical Immunology: In Practice

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What is already known about this topic? There are outpatient data for electronic consultations (e-consults) in allergy/ immunology (A/I) but no data for inpatient A/I consultations. What does this article add to our knowledge? We demonstrate that A/I inpatient e-consults are feasible, potentially less costly, and maintain requesting provider satisfaction for certain conditions. How does this study impact current management guidelines? E-consults are a strategy to improve A/I access in inpatient settings and are particularly relevant during the novel coronavirus infection pandemic. BACKGROUND: Electronic consultations (e-consults) are asynchronous clinician-to-clinician exchanges within the electronic health record (EHR). OBJECTIVE: We sought to demonstrate the utility of e-consults in allergy/immunology (A/I) inpatient consultations. METHODS: Inpatients ‡18 years of age for whom an A/I consultation was requested were eligible for an e-consult. An econsult was completed if considered appropriate by the A/I physician with recommendations made in the EHR. In-person consultation was performed for inpatients if deemed necessary. Likert scale satisfaction data were collected from requesting providers after the e-consultation. Cost was calculated using time-based billing codes plus the cost of penicillin allergy evaluation, if appropriate. RESULTS: Of the 109 inpatient consults, 78 (71.6%) were completed through an e-consult and 31 (28.4%) were completed by an in-person consult. The most common indication for an inpatient consult was evaluation of penicillin allergy in 73 (67%) patients. The most common reason to complete an in-person consult was the need to complete penicillin skin testing in 17 of the 31 (55%) patients. E-consults were completed in less time than in-person consults (15 minutes, interquartile range [IQR]: 10-15 vs 60 minutes, IQR: 45-60, P < .001) and had a shorter turnaround time (1 hour, IQR: 0.5-2 vs 7 hours, IQR: 3-19, P < .001). Management recommendations were followed at a similar rate regardless of type of consult (88% of e-consults vs 96% of in-person consults, P [ .162). A total of 97% of requesting providers reported an "excellent" or "good" impression of e-consults. E-consults were less costly than in-person consults. CONCLUSIONS: E-consults have utility in providing inpatient A/I consultation and may have advantages over in-person evaluation, while adequately maintaining provider satisfaction.

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Reduced Cost Of Specialty Care Using Electronic Consultations For Medicaid Patients

Cited by 49 publications

References 9 publications

Electronic consultations (E-consults) and their outcomes: a systematic review

Electronic consultations (E-consults) and their outcomes: a systematic review

Move-It: A Cluster-Randomised Digital Worksite Exercise Intervention in China: Outcome and Process Evaluation

Inpatient Electronic Consultations (E-consults) in Allergy/Immunology

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