内分泌咨询改善了缺医少药人群获得护理的机会

N. Minsky, R. Tamler
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引用次数: 1

摘要

纽约市西奈山医院的内分泌咨询服务旨在简化和加速获得内分泌学家的专业知识。在这里,我们详细介绍了如何根据初级保健提供者(pcp)的输入来设计我们的工作流程。此外,我们描述了我们的内分泌咨询服务的试点阶段的影响。在这个试点阶段,医疗补助诊所的提供者和那些访问居家患者的人使用18个原始的疾病特定模板和一个通用模板中的一个在医院的电子病历中放置eConsult订单。咨询顾问在回应模板中发送了基于证据的建议,其中包括参考资料的基本原理。作为正在进行的质量改进项目的一部分,pcp被要求完成一项包含两个问题的结案调查。70%的pcp表示,他们对新的或额外的行动方案得到了很好的建议,25%的人回答说,他们能够确认他们已经考虑过的行动方案。根据62%的受访者,最初考虑转诊,但由于咨询结果而避免转诊,超过其他学术机构报告的比率。我们独特地强调为建议提供详细的理由,这可能促成了这些结果。由于大多数答复者表示避免了正式咨询,扩大内分泌咨询服务可以减少大量不必要的内分泌转诊,加快更多的紧急访问,并降低成本。鉴于全国范围内内分泌学家的短缺,这一结果尤为重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Endocrine econsults improve access to care for the underserved
The endocrinology eConsult service at Mount Sinai Hospital, in New York City, was conceived to simplify and accelerate access to the expertise of endocrinologists. Here we detail how we designed our workflow according to input from primary care providers (PCPs). Additionally, we describe the impact of the pilot phase of our endocrinology eConsult service. In this pilot phase, providers in a Medicaid clinic and those making visits to homebound patients placed eConsult orders within the hospital's EMR using one of 18 original, disease-specific templates and one generic template. The eConsultant sent evidence-based recommendations in a response template, which included a rationale with references. As part of an ongoing quality improvement project, PCPs were asked to complete a two question closeout survey. Seventy percent of PCPs indicated that they got good advice for a new or additional course of action, and 25% answered that they were able to confirm a course of action that they already had in mind. Referral was originally contemplated, but avoided as a result of the eConsult according to 62% of respondents, exceeding rates reported at other academic institutions. Our unique emphasis on providing a detailed rationale for recommendations may have contributed to these outcomes. With a majority of respondents indicating that a formal consultation was averted, an expanded endocrine eConsult service could reduce a significant volume of unnecessary endocrine referrals, expedite more urgent visits, and reduce costs. This outcome is especially significant in light of a nationwide shortage of endocrinologists.
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