Published on March 7, 2014
Rapid Access to Consultative Expertise An innovative model for shared care Quality Forum 2014 Margot Wilson, RN, MSN, Director Chronic Disease Management Strategy, PHC Dr. Garey Mazowita, Family Physician, Shared Care Lead, PHC February 2014
Background Joint partnership between Providence Health Care and the Shared Care Committee, in collaboration with Vancouver Coastal Health Mission to improve care for patients with complex chronic conditions •Simplify the patient journey •Improve outcomes •Reduce costs •Strengthen relationships
Focus Groups •Family physicians •Specialists •Patients Need for improved •Communication •Access to specialists •Collaboration and relationships
Rapid Access to Consultative Expertise RACE • One phone line with a selection of specialty services • Started in June 2010 with 5 services • Currently at 21 services with plans to increase
Current Services Vancouver Coastal Health • Nephrology • Heart Failure • Psychiatry • Respirology • Endocrinology • Cardiovascular Risk & • Lipid Management • General Internal Medicine • Geriatrics • Geriatric Psychiatry • Addictions Medicine • Hand and Upper Limb Orthopedics • Dermatology • Obstetrics/gynecology (May 2014) Vancouver Coastal & Fraser Health • Cardiology • Rheumatology Provincial Services • Child & Adolescent Psychiatry • Chronic Pain • Treatment Resistant Psychosis • HIV Primary Care • Transgender Primary Care • Cardiac Transplantation
Evaluation: Key Themes Phase 1 – questionnaire/interviews • “Excellent resource” • “Would like to see it expanded” • Viewed as a service that could “…fill the gap…” Phase 2 – online survey • High user satisfaction – all would use the service again, 95% recommend usage to colleagues • All FPs noted that RACE − Reduced the number of unnecessary referrals to specialist care − Prevented ED visits Phase 3 – Interviews/survey • 83% of respondents believed it helped manage care for their patients
How RACE Impacts Practice • • • • • User-friendly 'decision support system' Improves clinical judgment Receive medical education Increases knowledge capacity Enhances overall practice efficiencies
Results & Outcomes (>10,000 calls, data based on 20% of calls) • 80% of calls answered within 10 mins • 90% are <15 min in length • 60% avoided face-to-face consults • 32% avoided ED visits Reason for Call: Ii • General management, diagnostic, therapeutics • Improved patient & provider experience • Improved efficiencies Recommendation: • Improved ED flow • Medication, additional testing, reassurance of plan • Increased specialist capacity Cost savings – up to $200/call
Key Learnings from RACE • One size does not fit all • Care to avoid replacing well established effective communication lines • No disruption of referral patterns • Requires criteria for specialist participation – Response time, collegial interaction, knowledge transfer • Requires limited resources – Coordination of schedules/re-routing numbers – Medical Services Plan billing code • Patient participation was key in the design • Keep is simple • Be responsive • Marketing is key
RACE App • For iPhones and Androids • No more listening to the tedious VM • To download - search RACEconnect
Provincial Scale Up
RACE Process Identify Needs Service requirements Program management Engage Marketplace Collaboratively Decide
Identify Needs Providence Health Care Northern Surrey North Delta Partners in Care Kootenay Boundary South Island • Held several team meetings • Discussed options • Need to make it local/regional • Need to have some consistency • Need flexibility
Collaboratively Decide Physicians Users Providers Local Sites Partners • We will need input from stakeholders • Need to select optimal strategy: 1 vendor or multiple • Cost share • Solution aligns with long term plan • Solution allows for integration
The Family Physician Perspective “... It is fantastic to be able to get answers immediately that I normally would either • refer to a specialist and have to wait months for an appointment, • try and look up online but not be confident of the answer, • play telephone tag or fax back and forth with a specialist regarding the clinical situation or, • just take my best guess with the clinical situation. It has given me a level of professional satisfaction, professional empowerment and improved patient care.” Family practitioner, frequent user of the RACE line
The Specialist Perspective “I find myself educating pediatricians, GPs, and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration. I learn something about the types of patients and resources available to front-line clinicians and physicians, and they learn something about child and adolescent psychiatry.” Specialist, provides service on the RACE line
Summary RACE has the potential to: • Enhance the care experience by • • • • Population health improved • • provide knowledge transfer improve the specialist/primary care interface through improved communication simplify the patient journey access to care is enhanced Per capita cost of health care • at least controlled – avoidable consults and emergency visits
Online Resources on RACE •http://www.RACEconnect.ca •http://www.youtube.com/watch?v=TQyKe0CKh_A •https://www.bcma.org/success-stories •http://blogs.vancouversun.com/2013/09/18/how-to-getspeedy-telephone-advice-from-medical-experts-the-raceprogram/ •http://www.cmaj.ca/content/early/2013/11/04/cmaj.1094627.full.pdf+html
www.RACEconnect.ca Margot Wilson firstname.lastname@example.org
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