Evaluating diverse electronic consultation programs with a common framework

Autor: Erin Keely, Frederick North, Steven R. Simon, Jennifer L Pecina, Delphine S. Tuot, Alice Hm Chen, Jay D. Orlander, Varsha G. Vimalananda, Elizabeth Murphy, Clare Liddy
Rok vydání: 2017
Předmět:
Male
Knowledge management
020205 medical informatics
02 engineering and technology
E-consult
Health informatics
Ambulatory Care Facilities
Health administration
Early adopter
0302 clinical medicine
0202 electrical engineering
electronic engineering
information engineering
Electronic consultation
Medicine
030212 general & internal medicine
Evaluation
lcsh:Public aspects of medicine
Health Policy
Nursing research
Health Services
United States Department of Veterans Affairs
Public Health and Health Services
Health Policy & Services
Female
Specialization
Research Article
Adult
Health Personnel
Specialty
Qualitative property
Nursing
Basic Behavioral and Social Science
03 medical and health sciences
Library and Information Studies
Clinical Research
Behavioral and Social Science
Remuneration
Humans
business.industry
Remote Consultation
lcsh:RA1-1270
United States
Good Health and Well Being
RE-AIM
Quadruple aim
San Francisco
Generic health relevance
Diffusion of Innovation
business
Delivery of Health Care
Zdroj: BMC Health Services Research
BMC health services research, vol 18, iss 1
BMC Health Services Research, Vol 18, Iss 1, Pp 1-11 (2018)
ISSN: 1472-6963
Popis: Background Electronic consultation is an emerging mode of specialty care delivery that allows primary care providers and their patients to obtain specialist expertise without an in-person visit. While studies of individual programs have demonstrated benefits related to timely access to specialty care, electronic consultation programs have not achieved widespread use in the United States. The lack of common evaluation metrics across health systems and concerns related to the generalizability of existing evaluation efforts may be hampering further growth. We sought to identify gaps in knowledge related to the implementation of electronic consultation programs and develop a set of shared evaluation measures to promote further diffusion. Methods Using a case study approach, we apply the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) and the Quadruple Aim frameworks of evaluation to examine electronic consultation implementation across diverse delivery systems. Data are from 4 early adopter healthcare delivery systems (San Francisco Health Network, Mayo Clinic, Veterans Administration, Champlain Local Health Integration Network) that represent varied organizational structures, care for different patient populations, and have well-established multi-specialty electronic consultation programs. Data sources include published and unpublished quantitative data from each electronic consultation database and qualitative data from systems’ end-users. Results Organizational drivers of electronic consultation implementation were similar across the systems (challenges with timely and/or efficient access to specialty care), though unique system-level facilitators and barriers influenced reach, adoption and design. Effectiveness of implementation was consistent, with improved patient access to timely, perceived high-quality specialty expertise with few negative consequences, garnering high satisfaction among end-users. Data about patient-specific clinical outcomes are lacking, as are policies that provide guidance on the legal implications of electronic consultation and ideal remuneration strategies. Conclusion A core set of effectiveness and implementation metrics rooted in the Quadruple Aim may promote data-driven improvements and further diffusion of successful electronic consultation programs. Electronic supplementary material The online version of this article (10.1186/s12913-018-3626-4) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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