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PreliminarySDPFindingsHowdoesSCAN‐ECHOfacilitatecommunicationbetweenprimaryandspecialtycareproviders?
CJ Koenig et [email protected] 18, 2015
AuthorsChristopher J. Koenig, PhD San Francisco VA
Matthew Wenger, MD San Francisco VA
Glenn Graham, MD San Francisco VA/VISN
Susan Kirsch, MD Office of Specialty Care
Thom Taylor, PhD Palo Alto VA
Steve Asch, MD, MPH Palo Alto VA
Catherine Rongey, MD, MPH San Francisco VA
Supported by VA HIV/Hepatitis QUERI SDP #12‐550(PIs: Rongey & Asch)
ConsultationsConsults enable cross‐provider collaboration.
• Written consults are traditional.• Communication quality is variable
• Inappropriate referral• Incomplete and partial information• Outcome uncertainty
Sewell, et al., 2013 AM J Med
HealthInformationTechnology
HIT proposes additional solutions.• E‐Consults• Video teleconferencing
• Project ECHO• VHA’s SCAN‐ECHO
Arora et al., 2011 N Engl J Med
1. Foster general & specialist communication2. Create knowledge networks 3. Improve patient health outcomes
KnowledgeGap
How does SCAN‐ECHO facilitate generalist‐specialist
communication and collaboration for specialty care needs?
ResearchQuestions1. What organizational features
characterize SCAN‐ECHO consults across sites?
2. What types of questions do generalists pose during SCAN‐ECHO consults?
3. How might generalist’s questions demonstrate familiarity with specialty care concerns?
DataCollection
Qualitative Data ScaleData TypesSCAN-ECHO
sessions
n= 2 VAMC sites
Video recordings
n= 32 sessionsSite 1 = 17Site 2 = 15
~45-60 minutes~1440-1920 min
Verbatim transcripts
20-30 pages/session
~640-960 pages
AnalysisDiscourse analysis
• Sociolinguistic, qualitative methodology• Naturalistic paradigm• Analyzes language in use in real‐world settings
• To describe recurrent activities and social actions
• To evaluate social practices for potential improvement
SCAN‐ECHOSession Organization
Team Work Logistics Consults Didactic
SessionsRecorded
Average Session Duration
Site 1 15 45 min
Site 2 17 63 min
SCAN‐ECHOConsultTypes
Site 1 Site 2
Full Case n= 39 (71%) n= 47 (78%)
Update(Generalist‐led)
n= 15 (27%) n= 2 (3%)
Summary(Specialist‐led)
n= 1 (2%) n= 11 (19%)
TOTAL n= 55 (100%) n= 60 (100%)
FullCaseConsultActivitiesSite 1
GEN Presentation 1m, 48s
Discussion 6m, 42s
TOTAL 8m, 30s
Site 2GEN Presentation 0m, 54s
SP Re‐Presentation 3m, 24s
Discussion 6m, 42s
TOTAL 11m, 00s
8%
31%61%
FullCaseConsultOrganization
Next Speaker
Full Case Presentation Discussion Social
Talk
Consult1+n
Consult 1
Consult Question
Assessment & Action Plan
VerbatimConsultQuestion
(Site 1, ID#131112, Case 3, Question 1)So, he’s a 60‐year‐old guy, hepatitis C, phenotype I. He has been told that he has a diffusely nodular liver. And I don’t think he had a history of a biopsy prior. As he was getting his housing and his other stuff stabilized, he had a series of follow‐up appointments. He had three things to do: an education class, which he completed; and two, he needs more psychosocial stuff; and then third thing is to complete the MRCP. So, he has this MRI result, and I just need feedback on how we’re interpreting it for him.
Datatransformation
VerbatimQuestion
StandardQuestion
GeneralizableQuestion
What is the meaning of test finding X?
So, he’s a 60‐year‐old guy, hepatitis C, phenotype I. He has been told that he has a diffusely nodular liver. And I don’t think he had a history of a biopsy prior. As he was getting his housing and his other stuff stabilized, he had a series of follow‐up appointments. He had three things to do: an education class, which he completed; and two, he needs more psychosocial stuff; and then third thing is to complete the MRCP. So, he has this MRI result, and I just need feedback on how we’re interpreting it for him.
How do I interpret this MRI result?Inductive Category: Interpreting Results
Datatransformation
VerbatimQuestion
StandardQuestion
GeneralizableQuestion
What is the meaning of test finding X?
So, he’s a 60‐year‐old guy, hepatitis C, phenotype I. He has been told that he has a diffusely nodular liver. And I don’t think he had a history of a biopsy prior. As he was getting his housing and his other stuff stabilized, he had a series of follow‐up appointments. He had three things to do: an education class, which he completed; and two, he needs more psychosocial stuff; and then third thing is to complete the MRCP. So, he has this MRI result, and I just need feedback on how we’re interpreting it for him.
How do I interpret this MRI result?Category: Interpreting Results
GeneralizableConsultQuestionsGeneralizable Question Site 1 Site 2 TOTALS
1 How do I access information about patient's history? 1 1*2 How do I order a non‐standard test X? 1 13 How should I treat finding or disease X? 1 14 What is condition X the cause of test finding Y? 1 15 What is the cause of physical finding X? 1 1*6 How do I communicate situation X to patient? 3 37 Is drug X indicated in situation Y? 2 1 38 Could this patient have disease or condition X? 1 3 4*9 Is condition X the cause of test finding Y? 2 5 7*10 NO QUESTION 1 8 911 What is the drug of choice given situation Y? 9 2 1112 Is test X indicated in situation Y? 6 9 15*13 How should I respond to patient request for treatment X? 9 6 1514 What is the cause of test finding X? 3 11 1415 How should I manage disease or finding X? 9 8 17*16 Should I start/dis/continue with drug X? 14 8 22
TOTALS 61 64 125
* Questions not identified in prior research
Limitations
Limits to generalizability• Two high‐performing sites• One disease condition (HCV)
Questions are one aspect of the consultation
New methodology opens the black box of provider‐to‐provider communication
ConclusionsProvider‐to‐provider verbal communication is largely unexplored and under‐researched.
SCAN‐ECHO consults have an advantage over standard consults.
• Provide clinical, psychological, and social contexts in a narrative format that can be tailored to the situation.
• Interactive feedback according to unique concerns.
Novel methodology can be used to• Evaluate complex (HIT) interventions• Develop recommendations for improving communication between providers
Thankyou!For questions or comments please contact:[email protected]