Improving referrals - Douglas Woodhouse - presentation ......“Female Problems” “Who...
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2011 Na’onal Health Policy and Nego’a’ons Conference Nego’a’ng for Pa’ent Centered Care October, 2011 Dr. Douglas Woodhouse MD BScEng CCFP [email protected] www.apixperformance.com Streamlining Referrals from Primary to Specialty Care
Transcript of Improving referrals - Douglas Woodhouse - presentation ......“Female Problems” “Who...
2011 Na'onal Health Policy and Nego'a'ons Conference Nego'a'ng for Pa'ent Centered Care
October, 2011
Dr. Douglas Woodhouse MD BScEng CCFP
www.apixperformance.com
Streamlining Referrals from Primary to Specialty Care
Do we need to improve our referral systems?
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How well do our referral systems answer our ques'ons?
Why? Who? What? When? Where? How?
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“Female Problems”
“Who specializes in eating disorders?”
“Send this referral to every orthopaedic surgeon in the area, it’s urgent…”
“Why did this GP send me a cardiac patient… I’m a nephrologist!”
“I wonder if the specialist ever saw my pa'ent?”
“What sort of X-rays should I send with the referral?”
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What should a referral system do? • As a pa'ent I want:
– A quick appointment – A choice of appropriate specialists – An appointment 'me that suits me – As few follow-‐up visits as possible
• As a primary care physician I want: – Visibility into available services and wait 8mes – Prepara'on and management advice – An automated process – Prompt feedback
• As a specialist I want: – The right pa8ent, in the right place, at the right 8me – A consult leVer with the informa'on I need – The ability to provide treatment during the ini'al visit – Follow-‐up that can be managed by the primary care physician
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Primary Care Physician’s Office
A simple model
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Primary Care Physician’s Office
Patient at Home Referral letter
Patient contacts specialist clinic for an appointment
Specialist Clinic
A simple model
Patient information package
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• Visibility into available specialists • Choice of referral • Gather required informa'on • Send referral leVer
• Receive referral leVer • Treatment planning • Appointment planning
• Unique iden'fier • Prepara'on and self-‐care advice • Appointment details • Booking instruc'ons
Primary Care
Physician Specialist
‘One size fits all’ solution: Patients with different problems referred and booked sequentially.
Specialist
Patients referred and booked based on medical indication, expected treatment and urgency. Focus on planning, standardization and increased productivity.
Based on referral pathways
Primary Care
Physician
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Step 1: Select a referral type
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Step 2: Choose a specialist
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Step 3: Review the referral protocol
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Step 4: Send the referral
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Step 5: Print pa'ent informa'on
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Step 6: Fill-‐in the informa'on
Comprehensive func'onality
• IT integra'on – EMRs (primary care and hospital)
– On-‐line appointment booking
• Mul'ple referral types – Allied health professionals, nursing homes, mental health care, etc.
– Diagnos'c requisi'ons
– ‘One-‐stop-‐shops’: single appointments with mul'ple specialists
– Tele-‐medicine
• Triage capability – Urgent bookings
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Results
Patients - 59% fewer hospital visits - 43% fewer follow-up consultations - Better informed and more satisfied with the referral process Primary Care Physicians - Rapid feedback after referrals - Reduction of unnecessary phone calls - Lower administrative costs Specialists - 57% reduction in urgent referrals - Fewer ‘no-shows’ for appointments - Fewer repeated diagnostics
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Current situa'on
• 49 hospitals (out of ~100) • 15 mental health ins'tu'ons • 14 independent treatment centers • Homecare, diagnos'c centers
• 6200 primary care docs • ~ 1M referrals last year • > 100 000 diagnos'c requisi'ons
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What are the key success factors?
Referral Applica'on
Consulta'ons
Diagnos'cs (lab and imaging)
Tele-‐consulta'ons
IT communica'on systems
Directory of Services
Standard method for all referrals
Local agreement on referral pathways
Save 'me, higher quality, save money
Adherence and monitoring
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Can we do this in Canada? A business case for reducing appointments
• A 50 year-‐old male presents to his physician with a suspicious skin lesion on his face
• Referred to a dermatologist for excision
Image Source: Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology Klaus Wolff, Richard Allen Johnson, Dick Suurmond Copyright 2005, 2001, 1997, 1993 by The McGraw-‐Hill Companies. All Rights reserved.
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Primary Care Pathology and incision check, follow-‐up instruc'ons
Dermatology
Pathology and incision check, follow-‐up instruc'ons
Dermatology
Lesion excision
Laboratory
INR check
Dermatology
Ini'al consulta'on
Primary Care
Ini'al consulta'on
Can we do this in Canada? A business case for reducing appointments
Primary Care
Pathology and incision check, follow-‐up instruc'ons
Dermatology
BCC excision
Primary Care
Ini'al consulta'on, photo, biopsy, INR mgmnt
Primary care billings change by -‐1% per
hour
Health system costs decrease
by $27
Dermatologist billings change by +55% per
hour
Pa8ents save 3 visits, 6 hours lost work and
$180
Calcula'ons based on the Alberta fee code schedule 22
Can we do this in Canada?
• Ensure ease-‐of-‐use for physicians • Financially aVrac've • Develop:
– A directory of services – Regional referral pathways
• Provide incen'ves for: – Pre-‐ and post-‐care by primary care docs
– ‘One-‐stop-‐shop’ specialist referrals
– Developing and maintaining referral pathways
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