Implementation and Evaluation of the Safety Net Specialty Care Program in the Denver Metropolitan Area
| Autor: | Tracy Copeland, Sarah Dutcher, Chris Fellenz, John J Reusch, Neysa Bermingham, Elizabeth A. Bayliss, Deborah Lantz, Lynnette M Namba, Meredith P. Fort |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Program evaluation Telemedicine medicine.medical_specialty Colorado Referral Attitude of Health Personnel Office Visits Safety net Specialty Health Services Accessibility 03 medical and health sciences 0302 clinical medicine Patient satisfaction Physicians Health care Humans Medicine 030212 general & internal medicine Referral and Consultation Medically Uninsured Medical education 030505 public health business.industry Communication General Medicine Health Services Middle Aged Original Research & Contributions Patient Satisfaction Family medicine Female Comprehensive Health Care Electronics Thematic analysis 0305 other medical science business Case Management Safety-net Providers Program Evaluation Specialization |
| Zdroj: | The Permanente Journal. 21 |
| ISSN: | 1552-5775 1552-5767 |
| Popis: | Objectives In response to limited access to specialty care in safety-net settings, an integrated delivery system and three safety-net organizations in the Denver, CO, metropolitan area launched a unique program in 2013. The program offers safety-net providers the option to electronically consult with specialists. Uninsured patients may be seen by specialists in office visits for a defined set of services. This article describes the program, identifies aspects that have worked well and areas that need improvement, and offers lessons learned. Methods We quantified electronic consultations (e-consults) between safety-net clinicians and specialists, and face-to-face specialist visits between May 2013 and December 2014. We reviewed and categorized all e-consults from November and December 2014. In 2015, we interviewed 21 safety-net clinicians and staff, 12 specialists, and 10 patients, and conducted a thematic analysis to determine factors facilitating and limiting optimal program use. Results In the first 20 months of the program, safety-net clinicians at 23 clinics made 602 e-consults to specialists, and 81 patients received face-to-face specialist visits. Of 204 primary care clinicians, 103 made e-consults; 65 specialists participated in the program. Aspects facilitating program use were referral case managers' involvement and the use of clear, concise questions in e-consults. Key recommendations for process improvement were to promote an understanding of the different health care contexts, support provider-to-provider communication, facilitate hand-offs between settings, and clarify program scope. Conclusion Participants perceived the program as responsive to their needs, yet opportunities exist for continued uptake and expansion. Communitywide efforts to assess and address needs remain important. |
| Databáze: | OpenAIRE |
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