Impact of Hematology Electronic Consultations on Utilization of Referrals and Patient Outcomes in an Integrated Health Care System

2021 ◽  
Author(s):  
Talib Dosani ◽  
Jenny Xiang ◽  
Kaicheng Wang ◽  
Yanhong Deng ◽  
Nathan T. Connell ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Outcomes ◽  
Health Care System ◽  
Hematologic Malignancy ◽  
Veterans Affairs ◽  
Face To Face ◽  
Periprocedural Management ◽  
Integrated Health Care System ◽  
The Impact ◽  
Care System

INTRODUCTION Electronic consultations (e-consults) may be a valuable tool in the current era of increased demand for hematologists. Despite the increasing use of e-consults in hematology, their optimal utilization and impact on patient outcomes and workload are largely unknown. METHODS In this retrospective cohort study, we studied the hematology consult experience at Veterans Affairs Connecticut from 2006 to 2018. We included 7,664 hematology consults (3,240 e-consults and 4,424 face-to-face [FTF] consults) requested by 1,089 unique clinicians. RESULTS We found that e-consults were rapidly adopted and used equally among physicians of different degrees of experience. The number of FTF consults did not decrease after the introduction of e-consult services. E-consults were preferentially used for milder laboratory abnormalities that had been less likely to result in a consult before their availability. Referring clinicians used e-consults preferentially for periprocedural management, anemia, leukopenia, and anticoagulation questions. Eighty-three percent of e-consults were resolved without needing an FTF visit in the year after the consult. Consults for pancytopenia, gammopathy, leukocytosis, and for patients with known malignancy were less likely to be resolved by e-consult. Among patients who were diagnosed with a new hematologic malignancy after their consult, having an e-consult before an FTF visit did not adversely affect survival. CONCLUSION In summary, e-consults safely expanded delivery of hematology services in our health care system but increased total consult volume. We report novel data on what types of consults may be best suited to the electronic modality, the impact of e-consults on workload, and their optimal use and implementation.

Abstract 162: Procedural and 1-Year Outcomes between PCI Centers with and without On-Site CT Surgery: Insights from the VA CART Program

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Thomas M Maddox ◽  
Maggie Stanislawski ◽  
Colin O’Donnell ◽  
Mary E Plomondon ◽  
Steve Bradley ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Patient Outcomes ◽  
Health Care System ◽  
P Value ◽  
All Cause Mortality ◽  
Procedural Complications ◽  
Va Health Care System ◽  
The Impact ◽  
Care System

Background: Clinical trials demonstrate that percutaneous coronary intervention (PCI) can be safely performed at medical centers without on-site cardiothoracic (CT) surgery, and current PCI guidelines support this practice with effective quality oversight. Translation of these trial findings and guideline recommendations into clinical practice has not been described. In 2005, the VA initiated a policy to expand PCI access by performing procedures at centers without on-site CT surgery under strict quality standards. The impact of this policy on procedural and longer-term patient outcomes has not been evaluated. Methods: We studied all PCIs conducted in the VA health care system between 2007-2010. We used data from the VA Clinical Assessment, Reporting, and Tracking (CART) Program, a national clinical quality program that collects real-time data on coronary procedures, procedural complications, and outcomes. Procedural complications (need for emergent CABG and in-lab death), 1-year all-cause mortality, myocardial infarction (MI), and rates of repeat revascularization procedures were compared by presence of on-site CT surgery. We used multivariate survival analysis to assess the association between the presence of on-site CT surgery and 1-year outcomes. The analyses were further stratified by procedural indication (ACS vs. elective) and cath lab PCI volume (≥ vs. <165 PCIs/year). Results: 24,387 patients received a PCI at 59 centers in the VA health care system between 2007-2010. 6,900 (28.3%) patients underwent PCI at 19 centers without on-site CT surgery. Rates of procedural complications were similar for PCI centers with and without on-site CT surgery (emergent CABG: 13 (0.1%) at PCI centers with on-site CT surgery vs. 2 (<0.05%) at PCI centers without on-site CT surgery, p-value 0.26; deaths: 15 (0.1%) at PCI centers with on-site CT surgery vs. 5 (0.1%) at PCI centers without on-site CT surgery, p-value 0.74). Adjusted 1-year combined all-cause mortality and MI rates were similar between centers (HR 0.995, 95% CI 0.84, 1.17), but revascularization rates were higher at sites without on-site CT surgery centers (HR 1.20, 95% CI 1.05, 1.33). Neither PCI indication nor cath lab volume significantly modified these results. Conclusions: Our findings demonstrate that procedural and 1-year patient outcomes are similar between PCI centers with and without on-site CT surgery. These results indicate that the clinical trial evidence of PCI safety without on-site CT surgery can be effectively translated to clinical practice. The VA’s policy allowing for PCI centers without on-site CT surgery in the setting of a quality oversight program may serve as a potential model for improving PCI access in large, integrated health care systems.

Impact of an Intensive Care Unit Telemedicine Program on Patient Outcomes in an Integrated Health Care System

2014 ◽  
Vol 174 (7) ◽  
pp. 1160 ◽  
Author(s):  
Boulos S. Nassar ◽  
Mary S. Vaughan-Sarrazin ◽  
Lan Jiang ◽  
Heather S. Reisinger ◽  
Robert Bonello ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Health Care System ◽  
Integrated Health Care ◽  
Integrated Health ◽  
Integrated Health Care System ◽  
Care System

scholarly journals A Survey of Chiropractic Academic Affiliations Within the Department of Veterans Affairs Health Care System

2007 ◽  
Vol 21 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Andrew S. Dunn
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Clinical Training ◽  
Clinical Care ◽  
Veterans Affairs ◽  
Survey Method ◽  
Department Of Veterans Affairs ◽  
Medical Facilities ◽  
The Impact ◽  
Care System

Purpose: With the recent implementation of chiropractic into the Department of Veterans Affairs (VA) Health Care System, chiropractic institutions nationwide now share common educational ground with many of the nation's medical schools and other educational institutions. Chiropractic students may undergo clinical training within VA medical facilities that have affiliation agreements with chiropractic institutions. The purpose of this study was to gain a greater understanding of the current state of chiropractic academic affiliations within the VA. Methods: Survey method was utilized to obtain information about the program design and operation of VA chiropractic academic affiliations. Results: Chiropractic academic affiliations have been establishedwithin four VA medical facilities in association with three chiropractic colleges. There was considerable variation in staffing and internship duration among the locations. Conclusion: The four existing chiropractic academic affiliations were dissimilar in terms of their design and operation with different strengths and program characteristics identified. Additional study is indicated to determine the impact that program variation has on the clinical care and educational functions of VA chiropractic academic affiliations. (The Journal of Chiropractic Education 21(2): 138–143, 2007)

The impact of the iPLEDGE program on isotretinoin fetal exposure in an integrated health care system

2011 ◽  
Vol 65 (6) ◽  
pp. 1117-1125 ◽  
Author(s):  
Janet Shin ◽  
T. Craig Cheetham ◽  
Linda Wong ◽  
Fang Niu ◽  
Elizabeth Kass ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Integrated Health Care ◽  
Fetal Exposure ◽  
Integrated Health ◽  
Integrated Health Care System ◽  
The Impact ◽  
Care System

scholarly journals COVID-19 Infections and Outcomes in a Live Registry of Heart Failure Patients Across an Integrated Health Care System

2020 ◽  
Author(s):  
Cesar Caraballo ◽  
Megan McCullough ◽  
Michael A. Fuery ◽  
Fouad Chouairi ◽  
Craig Keating ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Health Care System ◽  
Integrated Health Care ◽  
Manuscript Preparation ◽  
Heart Failure Patients ◽  
Integrated Health ◽  
Integrated Health Care System ◽  
The Impact ◽  
Care System

AbstractBackgroundPatients with comorbid conditions have a higher risk of mortality with SARS-CoV-2 (COVID-19) infection, but the impact on heart failure patients living near a disease hotspot is unknown. Therefore, we sought to characterize the prevalence and outcomes of COVID-19 in a live registry of heart failure patients across an integrated health care system in Connecticut.MethodsIn this retrospective analysis, the Yale Heart Failure Registry (NCT04237701) that includes 26,703 patients with heart failure across a 6-hospital integrated health care system in Connecticut was queried on April 16th, 2020 for all patients tested for COVID-19. Sociodemographic and geospatial data as well as, clinical management, respiratory failure, and patient mortality were obtained via the real-time registry. Data on COVID-19 specific care was extracted by retrospective chart review.ResultsCOVID-19 testing was performed on 900 symptomatic patients, comprising 3.4% of the Yale Heart Failure Registry (N=26,703). Overall, 206 (23%) were COVID-19+. As compared to COVID-19-, these patients were more likely to be older, black, have hypertension, coronary artery disease, and were less likely to be on renin angiotensin blockers (P<0.05, all). COVID-19- patients tended to be more diffusely spread across the state whereas COVID-19+ were largely clustered around urban centers. 20% of COVID-19+ patients died, and age was associated with increased risk of death [OR 1.92 95% CI (1.33–2.78); P<0.001]. Among COVID-19+ patients who were ≥85 years of age rates of hospitalization were 87%, rates of death 36%, and continuing hospitalization 62% at time of manuscript preparation.ConclusionsIn this real-world snapshot of COVID-19 infection among a large cohort of heart failure patients, we found that a small proportion had undergone testing. Patients found to be COVID-19+ tended to be black with multiple comorbidities and clustered around lower socioeconomic status communities. Elderly COVID-19+ patients were very likely to be admitted to the hospital and experience high rates of mortality.

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