title: Asynchronous vascular consultation via electronic methods: A feasibility pilot.
abstract: 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.
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA mchittle@mgh.harvard.edu.
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Chittle
authors.affiliation: Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Sandhya K
authors.initials: SK
authors.lastname: Rao
authors.affiliation: Paul and Phyllis Fireman Vascular Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jaff
authors.affiliation: Division of Vascular and Endovascular surgery, Paul and Phyllis Fireman Vascular Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Virendra I
authors.initials: VI
authors.lastname: Patel
authors.affiliation: Paul and Phyllis Fireman Vascular Center, Massachusetts General Hospital, Boston, MA, USA Division of Vascular and Endovascular surgery, Paul and Phyllis Fireman Vascular Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Gallen
authors.affiliation: Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Radhika
authors.initials: R
authors.lastname: Avadhani
authors.affiliation: Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Ferris
authors.affiliation: Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Wasfy
mesh_terms: D000046:Academic Medical Centers; D060866:Accountable Care Organizations; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D003695:Delivery of Health Care / Q000379:methods*; D003952:Diagnostic Imaging / Q000379:methods; D005080:Exercise Test; D005240:Feasibility Studies; D006801:Humans; D008499:Medical Records; D009819:Office Visits; D017060:Patient Satisfaction; D058007:Physicians, Primary Care / Q000523:psychology; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D011379:Prognosis; D015397:Program Evaluation; D012017:Referral and Consultation; D019114:Remote Consultation / Q000379:methods*; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D014652:Vascular Diseases / Q000175:diagnosis* / Q000628:therapy
keywords: Accountable Care Organization (ACO); asynchronous consult; care delivery; chronic disease management; e-consult; vascular care