Rapid Access to Consultative Expertise
- 1. An innovative model for shared care Rapid Access to Consultative Expertise RACE March, 2012 Margot Wilson and the RACE Team
- 2. 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
- 3. Context • Deterioration in Relationships • Disconnect of acute hospital care and primary community care Needs Assessment with FPs and specialists identified: • Need for improved communication • Improved access to specialists • Improved collaboration and relationships
- 4. Pre Referral Process Strategic Workflow Telephone Advice Line Rapid Access to Unattached Patient Consultative Expertise Strategy Trigger for Re-Referral RACE Referral Process Compacts Patients as Partners Referral Process Shared Care Plans Consult Process
- 5. Rapid Access to Consultative Expertise - RACE • Real-time telephone advice line to provide support for FPs • PHC/SCC initiative launched June 2010 • One phone line with a selection of services – Cardiology, Nephrology, Respiratory, Endocrinology, CV Risk & Lipid Management, Internal Medicine, Psychiatry, Geriatrics, Gastroenterology, Rheumatology, Chronic Pain, • Involves specialists from PHC, VGH, Lion’s Gate, Royal Columbian • Future Specialties: Child Psychiatry
- 6. 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 • 95% aware of RACE • 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 – In Progress - Interviews/survey • 83% of respondents believed it helped manage care for their patients
- 7. Key Metrics 2031 calls (TELUS reports Sept 2010 – Dec 2011) Metrics based on data from 696 calls •77% of calls were answered within Potential for: 10 minutes •Improved patient experience •88% of the calls were <15 minutes in length •Improved provider experience •Reason for Call: •Improved efficiencies – General management, diagnostic, therapeutics •Improved ED flow •Recommendation: •Cost savings – Medication, additional testing, reassurance of FP plan •Increased specialists capacity •60% avoided face-to-face consults •32% avoided ED visits
- 8. Key Learnings • One size does not fit all • Care to avoid replacing well established effective communication lines • 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
- 9. Challenges/Strategies • Marketing the service to family practice • Physician engagement • Identifying a technology that meets the needs of specialists and family practitioners • Securing ongoing funding to support the service – Technology, admin support
- 10. Spreading the Innovation • Collaboration is key to successful spread − Divisions of FP, Health Authorities • Needs assessment of communities across the province • “RACE-in-a-Box” – Information on how to start up a telephone advice line – Decision support tree with key questions • 3 services currently will trial a provincial service – rheumatology, chronic pain, child psychiatry
- 11. Summary RACE has the potential to: Enhance the care experience by • provide knowledge transfer • improve the specialist/FP interface through improved communication • simplify the patient journey. Population health improved • access to care is enhanced. Per capita cost of health care • at least controlled – potentially avoidable consults and emergency visits.
- 12. “It is such a useful service - every time I call I receive timely and helpful advice on some challenging issues”. Family practitioner, frequent user of the RACE line