In this new study, Massachusetts General Hospital researchers determined that e-consult use for ambulatory care has increased during the COVID-19 pandemic. The study, which highlights e-consult’s ability to provide specialist access while maintaining social distancing and reducing PPE demand, used an interrupted time series model to analyze e-consult use from February 1 through April 1st. The “intervetion date” of March 11th is the day that Massachusetts declared its pandemic-related state of emergency
The study found a a proportional increase of econsult volumes over ambulatory care volumes of 5% to 19% after March 11th. The study’s authors conclude that their findings “suggest an increase in e-consult utilization associated with the COVID-19 pandemic in the USA…[as a] promising method of ambulatory consultative care delivery [that] can potentially replace some specialty consultations in a manner that provides clinical guidance while reducing the risk of in-person visits to both patients and physicians.”
Quality: “Utility, Appropriateness, and Content of Electronic Consultations Across Medical Subspecialties: A Cohort Study” Annals of Internal Medicine, May 2020
For a cohort study of Partners HealthCare System’s e-consult program, researchers developed novel metrics to assess econsults’ utitity, appropriateness and content. The study, which included hematology, infectious disease, dermatology, rheumatology, and psychiatry e-consults from October 2017 to November 2018, found the following results:
- Across all specialties, most e-consults were completed within 1 day or less (range: 73.1% for psychiatry to 87.8% for infectious disease)
- From 84 geographic locations, most referring providers were physicians (79.0%) and PCPs (75.8%), and most were affiliated with tertiary care practices (83.2%)
- 70% of e-consults were deemed appropriate based on review of patient records
The study’s authors conclude: “We found high rates of appropriate e-consults across specialties, supporting the hypothesis that e-consults are an efficient care model compared with in-person visits.” To learn more, view the E-Consult Workgroup Webinar research presentation by lead author Salman Ahmed, MD, MPH of Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health.
Patient Satisfaction: “Comparing Patients’ Experiences with Electronic and Traditional Consultation: Results from a Multisite Survey” Journal of General Internal Medicine, February 2020
A series of patient surveys conducted by AAMC Project Core deliver valuable insights into patient awareness of e-consults by comparing patient experience with e-consults to patient experience with in-person referrals. Among the 8087 patients that completed surveys, 11.6% had e-consults and 88.4% had in-person referrals. Both groups reported similar levels of satisfaction and specialist recommendation understanding:
- 81.4% of e-consult patients and 81.9% of in-person referral patients reported satisfaction with the specialists’ recommendations
- 97% of e-consult patients and 95% in-persons referral patientes agreed that specialists recommendations were clearly explained
Both patient groups also reported similar acceptance of e-consults and in-person referrals. This comparative research counters provider concerns that patients would perceive e-consults as a low quality care, adding another layer to the high value of e-consults.
Patient Education: “Patients Assess an eConsult Model’s Acceptability at 5 US Academic Medical Centers” Annals of Family Medicine, January/February 2020
To assess patient perspectives on e-consults, researchers conducted primary patient focus groups at five AAMC Project CORE academic medical centers to explore patient opinions about e-consults.
“Nearly all focus groups responded positively to the idea of [e-consult] and were enthusiastic about its potential benefits…All focus groups felt that econsult would result in better care, time and cost savings, and shorter wait times for appointments with specialists,” the authors note.
Patients maintained a positive perspective on e-consults as long as they did not replace needed in-person appointments and that patients would not be charged a copay for their use. The focus group input revealed that “patient involvement in outreach and education efforts could help to improve econsult models and enhance their uptake.”