Abstract

Objective

To explore Veterans Health Administration clinicians’ perspectives on the idea of redesigning electronic consultation (e-consult) delivery in line with a hub-and-spoke (centralized) model.

Materials and Methods

We conducted a qualitative study in VA New England Healthcare System (VISN 1). Semi-structured phone interviews were conducted with 35 primary care providers and 38 specialty care providers, including 13 clinical leaders, at 6 VISN 1 sites varying in size, specialist availability, and e-consult volume. Interviews included exploration of the hub-and-spoke (centralized) e-consult model as a system redesign option. Qualitative content analysis procedures were applied to identify and describe salient categories.

Results

Participants saw several potential benefits to scaling up e-consult delivery from a decentralized model to a hub-and-spoke model, including expanded access to specialist expertise and increased timeliness of e-consult responses. Concerns included differences in resource availability and management styles between sites, anticipated disruption to working relationships, lack of incentives for central e-consultants, dedicated staff’s burnout and fatigue, technological challenges, and lack of motivation for change.

Discussion

Based on a case study from one of the largest integrated healthcare systems in the United States, our work identifies novel concerns and offers insights for healthcare organizations contemplating a scale-up of their e-consult systems.

Conclusions

Scaling up e-consults in line with the hub-and-spoke model may help pave the way for a centralized and efficient approach to care delivery, but the success of this transformation will depend on healthcare systems’ ability to evaluate and address barriers to leveraging economies of scale for e-consults.

中文翻译：

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电子咨询和规模经济：临床医生对扩大电子咨询服务的看法的定性研究

摘要

客观的

探讨退伍军人健康管理局临床医生对根据中心辐射（集中式）模型重新设计电子咨询（e-consult）交付的想法的看法。

材料和方法

我们在 VA 新英格兰医疗保健系统 (VISN 1) 中进行了一项定性研究。对 35 名初级保健提供者和 38 名专科保健提供者（包括 13 名临床负责人）在 6 个 VISN 1 站点进行了半结构化电话访谈，这些站点的规模、专家可用性和电子咨询量各不相同。访谈包括探索作为系统重新设计选项的轴辐式（集中式）电子咨询模型。应用定性内容分析程序来识别和描述显着类别。

结果

参与者看到了将电子咨询交付从分散模式扩展到中心辐射模式的几个潜在好处，包括扩大对专业知识的访问和提高电子咨询响应的及时性。担忧包括站点之间资源可用性和管理风格的差异、工作关系的预期中断、缺乏对中央电子顾问的激励、专职员工的倦怠和疲劳、技术挑战以及缺乏变革动力。

讨论

基于美国最大的综合医疗保健系统之一的案例研究，我们的工作确定了新的问题，并为考虑扩大电子咨询系统的医疗保健组织提供了见解。

结论

根据中心辐射模式扩大电子咨询规模可能有助于为集中和高效的护理提供方法铺平道路，但这种转型的成功将取决于医疗保健系统评估和解决利用障碍的能力电子咨询的规模经济。