Abstract Details

Title Quality Improvement and Clinical Innovation: Trial of an e-consult system in an outpatient tertiary care neurology practice for patients in an Accountable Care Organization model

Topic Practice, Policy, and Ethics

Presentation(s) P9 - Poster Session 9 (12:00 PM-1:00 PM)

Poster/Presentation
Number 7-006

Objective To determine whether an e-consultation model results in shared savings and faster access to neurological care for patients in the Accountable Care Organization insurance model

Background Access to neurological consultation is often limited by provider availability and distance that patient lives from the neurology practice. The Accountable Care Organization model emphasizes shared cost savings and therefore econsults may be an appropriate mechanism to achieve cost savings, increase the time in which appropriate care is delivered and increase patient and provider satisfaction.

Design/Methods Schedulers at the UT Southwestern outpatient neurology practice referred all new consults made during the month of February 2017 to a single neurologist (RRD) for e-consultation as a message with the title “ACO consult”. Following neurologist evaluation one of four decisions ensued. Decision A: brief opinion rendered based on documentation alone; Decision B: if documentation is insufficient, neurologist will call patient and then determine whether patient needs to be seen or if not provide recommendations Decision C: based on either records review or phone call the patient is scheduled with reviewing neurologist. Decision D: the patient is scheduled in specialty clinic

Results 24 patients were suitable for econsultation. Average age was 66 years. Fifteen patients (62.5%) were insured by Medicare. 11 referrals were from Internal Medicine or subspecialities (Endocrine, Rheumatology, Cardiology) while 3 referrals each came from Surgery and Otorhinolaryngology. Six patients were referred for cognitive issues, 5 for movements disorders (4 for tremors) and three each for epilepsy and headaches. Seventeen patients (70%) required speciality clinic consultation (Option D) while in 6 patients Option B (econsult resolved with patient phone call). In no patient was econsultation completed only by review of records. These outcomes were due to the complexity of the underlying patient population.

Conclusions Econsultation may not be suitable in a patient population with complex neurological issues.

Authors/Disclosures
Rohit Das, MD, F�鶹��ýӳ�� (VA Portland Healthcare System) PRESENTER	Dr. Das has received personal compensation for serving as an employee of Oregon Health Science University. Dr. Das has received personal compensation in the range of $10,000-$49,999 for serving as a Physician Advisor with Concentra .
Ailing E. Yang, MD	Dr. Yang has nothing to disclose.
	No disclosure on file
Debra Clamp, FACMPE (UT Southwestern Medical Center)	Ms. Clamp has nothing to disclose.
Jaya Trivedi, MD, F�鶹��ýӳ�� (UT Southwestern Medical Center)	The institution of Dr. Trivedi has received research support from Avidity.
Benjamin M. Greenberg, MD, F�鶹��ýӳ�� (UT Southwestern Medical Center)	Dr. Greenberg has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Greenberg has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Greenberg has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono. Dr. Greenberg has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amgen. Dr. Greenberg has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Sanofi/Genzyme. Dr. Greenberg has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech/Roche. Dr. Greenberg has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Signant. Dr. Greenberg has received personal compensation in the range of $500-$4,999 for serving as a Consultant for IQVIA. Dr. Greenberg has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sandoz. Dr. Greenberg has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Clene. Dr. Greenberg has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for TG Therapeutics. Dr. Greenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for IQVIA. Dr. Greenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abcuro. Dr. Greenberg has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Siegel Rare Neuroimmune Association. Dr. Greenberg has or had stock in GenrAb.Dr. Greenberg has or had stock in Clene.Dr. Greenberg has received intellectual property interests from a discovery or technology relating to health care. Dr. Greenberg has received publishing royalties from a publication relating to health care.
Padraig E. O'Suilleabhain, MD, F�鶹��ýӳ�� (UT Southwestern Medical Center)	The institution of Dr. O'Suilleabhain has received research support from ONO pharmaceutical. The institution of Dr. O'Suilleabhain has received research support from Integrated Research Laboratories.

�鶹��ýӳ��

�鶹��ýӳ��