Prior to March 2020, electronic consultations (eConsultations or eConsults) were increasingly being used by primary care clinicians to obtain specialist input. In a recent Yale-led study, authors explored how utilization changed during the COVID-19 pandemic when face-to-face care was limited.
Authors of the new paper in JAMA Network Open, “Trends in Utilization of Electronic Consultations Associated with Patient Payer and Language Among US Academic Medical Centers During the COVID-19 Pandemic,” performed a retrospective cohort study, looking at data from adult patient visits at Dartmouth-Hitchcock Medical Center; University of California, San Francisco; University of Colorado; University of Michigan; University of Washington; and Yale School of Medicine (YSM), during July 2019 through July 2020 to evaluate utilization of eConsults.
“We thought that perhaps because face-to-face visit care was limited, especially in the beginning [of the pandemic] that PCPs would be relying more on e-Consults to get specialist input. We completed an interrupted time series analysis and learned that in the first week of the pandemic, there was a significant increase in the eConsult proportion of specialty contact, which we defined as the ratio of e-Consults to the sum of e-Consults plus referrals,” explained first and corresponding author, Yale School of Medicine’s Anita Arora, MD, MBA, MHS, assistant professor of medicine (general medicine).
They reviewed data on 14,545 eConsultations and 189,776 referrals during the year. For the first 39 weeks of the study, the eConsult proportion of specialty contact remained stable, but then increased by 6.21% during the first week of the pandemic. As telehealth capability built up, specialists were seeing more patients through video visits and then when offices could reopen, the ratio declined and approached what had been seen before the pandemic. The authors also completed a stratified analysis, where they looked at language and payer, and saw that a similar trend existed for all groups, except for the uninsured and self-pay category.
“The main takeaway is that e-Consults played an important role in those early weeks of the pandemic in helping patients get specialist input when face to face care was limited,” said Renee Fekieta, PhD, MA, second author on the study and Data Analyst at Yale Medicine.
Both Arora and Fekieta serve on the Yale Medicine Population Health team, which has led the implementation of eConsults at Yale Medicine, which are offered by 30 adult and pediatric specialties and have helped patients receive the right care at the right time. Yale and the other health systems in the study participate in the Association of American Medical Colleges’ (AAMC) Project CORE (Coordinating Optimal Referral Experiences) focused on implementation of eConsults and enhanced referrals.
In addition to Arora and Fekieta, other authors include Zakia Nouri, MA, and Danielle Carder, MSc from the Association of American Medical Colleges; Megan M. Colgan, BA, Dartmouth-Hitchcock Medical Center; Anne Fuhlbrigge, MD, MS, University of Colorado School of Medicine; Sara L. Jackson, MD, MPH, University of Washington School of Medicine; Samuel Collins, DrPH, University of Virginia; Nathaniel Gleason, MD, University of California, San Francisco, and Julia Chen, MD, University of Michigan.
To learn more, read “Trends in Utilization of Electronic Consultations Associated with Patient Payer and Language Among US Academic Medical Centers During the COVID-19 Pandemic” in JAMA Network Open.
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