Abstract:
AIMS:Cardiac e-consults may be an effective way to deliver value-oriented outpatient cardiology care in an accountable care organization. Initial results of cardiac e-consults have demonstrated high satisfaction among both patients and referring providers, no known adverse events, and low rates of diagnostic testing. Nevertheless, differences between e-consults and traditional consults, effects of e-consults on traditional consult volume, and whether patients seek traditional consults after e-consults are unknown. METHODS AND RESULTS:We established a cardiac e-consult program on January 13, 2014. We then conducted detailed medical record reviews of all patients with e-consults to detect any adverse clinical events and detect subsequent traditional visits to cardiologists. We also performed 2 comparisons. First, we compared age, gender, and referral reason for e-consults vs traditional consults. Second, we compared changes in volume of referrals to cardiology vs other medical specialties that did not have e-consults. From January 13 to December 31, 2014, 1,642 traditional referrals and 165 e-consults were requested. The proportion of e-consults of all evaluations requested over that period was 9.1%. Gender balance was similar among traditional consults and e-consults (44.8% male for e-consults vs 45.0% for traditional consults, P = .981). E-consult patients were younger than traditional consult patients (55.3 vs 60.4 years, P < .001). After the introduction of cardiac e-consults, the increase in traditional cardiac visit requests was less than the increase in traditional visit requests for control specialties (4.5% vs 10.1%, P < .001). For e-consults with at least 6 months of follow-up, 75.6% patients did not have any type of traditional cardiology visit during the follow-up period. CONCLUSION:E-consults are an effective and safe mechanism to enhance value in outpatient cardiology care, with low rates of bounceback to traditional consults. E-consults can account for nearly one-tenth of total outpatient consultation volume at 1 year within an accountable care organization and are associated with a reduction in traditional referrals to cardiologists.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Wasfy JH,Rao SK,Kalwani N,Chittle MD,Richardson CA,Gallen KM,Isselbacher EM,Kimball AB,Ferris TGdoi
10.1016/j.ahj.2015.11.019subject
Has Abstractpub_date
2016-03-01 00:00:00pages
86-93eissn
0002-8703issn
1097-6744pii
S0002-8703(15)00694-8journal_volume
173pub_type
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pub_type: 杂志文章
doi:10.1016/0002-8703(86)90640-x
更新日期:1986-05-01 00:00:00
abstract:BACKGROUND:Declines in case fatality post-myocardial infarction (MI) have been observed over the past 3 decades. Few studies report socioeconomic disparities in survival post-MI. METHODS:We assessed 1-year case fatality among 9,116 incident MI patients included in the Atherosclerosis Risk in Communities community surv...
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pub_type: 杂志文章
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abstract::Reductions in mobility and cognitive function linked to accrual of brain microvascular disease related white matter hyperintensities (WMHs) on magnetic resonance imaging can occur in older hypertensive patients in as little as 2 years. We have designed a trial evaluating 2 levels of ambulatory blood pressure (ABP) con...
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pub_type: 杂志文章,随机对照试验
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更新日期:2013-03-01 00:00:00
abstract:BACKGROUND:Over 3 million patients annually present with symptoms suggestive of obstructive coronary artery disease (oCAD) in the United States (US), but a cardiac etiology is found in as few as 10% of cases. Usual care may include advanced cardiac testing with myocardial perfusion imaging (MPI), with attendant radiati...
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pub_type: 杂志文章,随机对照试验
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更新日期:2018-03-01 00:00:00
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pub_type: 杂志文章
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更新日期:2004-06-01 00:00:00
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pub_type: 杂志文章,meta分析,评审
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更新日期:2018-01-01 00:00:00
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pub_type: 临床试验,杂志文章
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更新日期:1991-01-01 00:00:00
abstract::The acute hemodynamic and hormonal effects of the oral angiotensin-converting enzyme (ACE) inhibitor lisinopril (MK-521) were assessed over a period of 96 hours in 12 patients with heart failure. This compound is the lysine analogue of enalaprilat (MK-422), is biologically active following absorption, and is cleared v...
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pub_type: 杂志文章
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更新日期:1986-07-01 00:00:00
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pub_type: 杂志文章
doi:10.1067/mhj.2001.118740
更新日期:2001-12-01 00:00:00
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pub_type: 杂志文章
doi:10.1016/0002-8703(86)90476-x
更新日期:1986-10-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2015.04.016
更新日期:2015-08-01 00:00:00
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pub_type: 杂志文章
doi:10.1016/0002-8703(85)90458-2
更新日期:1985-10-01 00:00:00
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pub_type: 杂志文章
doi:10.1016/0002-8703(89)90868-5
更新日期:1989-05-01 00:00:00
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pub_type: 杂志文章
doi:10.1016/j.ahj.2006.12.014
更新日期:2007-04-01 00:00:00
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pub_type: 杂志文章
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2000-07-01 00:00:00
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pub_type: 杂志文章
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更新日期:1996-02-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:1989-11-01 00:00:00
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pub_type: 杂志文章
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更新日期:1991-06-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2015-02-01 00:00:00
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pub_type: 杂志文章
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更新日期:1985-09-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2006-10-01 00:00:00
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pub_type: 杂志文章
doi:10.1016/j.ahj.2005.12.001
更新日期:2006-08-01 00:00:00
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pub_type: 杂志文章
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更新日期:1976-12-01 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
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