Overview

This project utilized analysis of eConsults from a metropolitan county-level public services agency and its affiliated health centers to a community-based health and social services resource hub to improve bi-directional communication and strengthen the social service delivery capacity of community-based organizations.

Organization Name

Los Angeles County of Department of Public Health, Los Angeles County Department of Health Services, & the Wellness Center at the LAC+USC Medical Center Foundation

Organization Type

• Community organization
• Public Health System

National/Policy Context

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Local/Organizational Context

• The Wellness Center at the Historic General Hospital is located on the campus of one of LA County’s Department of Health Services’ (DHS) hospitals and is home to over twenty community organizations.
  • These organizations primarily offer no-cost services including healthcare enrollment, chronic disease management, exercise and nutrition education, and mental health services.
  • Since The Wellness Center is already embedded in the eConsult (see Glossary) network system,
    there is an opportunity for bi-directional communication between service
    providers in different networks.

Patient Population Served and Payor Information

• DHS serves its patient population through an integrated system of four major hospitals, 20 ambulatory care centers, and community clinic partners.
• The majority of DHS’s operations are supported by Medi-Cal, California’s Medicaid program.

Leadership

• Tony Kuo, MD MSHS (Director of the Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health)
• Amelia DeFosset, MPH (Chief of Health Policy and Assessment at the Division of Chronic
  Disease and Injury Prevention in DPH)
• Noel Barragan, MPH, MBA (Manager of Special Projects and Strategic Initiatives at the
  Division of Chronic Disease and Injury Prevention in DPH)
• Janina Morrison, MD, MPH (Medial Director of TWC)

Funding

Funding was provided, in part, through a cooperative agreement with the Centers for Disease Control and Prevention (#U58DP006619).

Research + Planning

• To better understand how healthcare representatives and providers perceive the eConsult
  network, DPH researchers analyzed approximately 4.5 years of eConsult data and conducted
  three in-depth interviews with DHS clinical providers and the Wellness Center (TWC) staff.
• They then used the results to develop a workflow pathway and identified opportunities for improvement (e.g., formal TWC protocols for responding to eConsults).

Tools or Products Developed

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Training

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Tech Involved

• eConsult/eReferral
• Electronic medical record

Team Members Involved

• Community Health Worker
• Physicians
• Researcher

Workflow Steps

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Budget Details

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Where We Are

• The project launched in fall 2018 and is ongoing.
•  Paper is currently being developed with an anticipated publishing date of Winter 2020/21.

Outcomes

• The retrospective study analyzing eConsult data collected between March 2014 and October 2018 aimed to understand the volume and sources of primary eConsult referrals, the conditions triggering referrals, and current workflow.
  • Since 2014, TWC has received a total of 1,381 referrals through eConsult.
  • 57% came from the DHS hospital system.
  • 18% came from DHS ambulatory centers and clinics.
  • 25% came from federally qualified health centers and community clinic partners.
• Other than in 2014, 2-5 individual providers made 20 or more referrals per year.
• Approximately 29% of referrals were attributed to pain, 23% to excess weight, and 23% to diabetes.
• Analysis results were used to develop formal protocols for TWC staff responding to eConsults to improve timeliness of response and bi-directional communication with referring providers.

Future Outcomes

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Benefits

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Unique Challenges

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Glossary

eConsult: a web-based system allowing for communication and electronic referrals between the four major hospitals and 20 ambulatory care centers (as well as specialty services to community clinics and federally qualified health partners) in the DHS county.

Sources

• Barragan, N., DeFosset, A., Morrison, J., & Kuo, T. (2019, June). Strengthening a Bi-Directional Referral and Communication Process to Enhance Clinical-Community Linkages for Low-Income Patients. Poster session at the Academy Health Annual Research Meeting, Washington, D.C., United States. 
• Skeith L, Mohamed M, Karovitch A, Liddy C, Afkham A, Archibald D, Keely E. The use of eConsults to improve access to specialty care in thrombosis medicine. Thromb Res. 2017 Dec;160:105-108. doi: 10.1016/j.thromres.2017.11.002. Epub 2017 Nov 7.
• Ross MK, Wei W, Ohno-Machado L. “Big data” and the electronic health record. Yearb Med Inform. 2014 Aug 15;9:97-104. doi: 10.15265/IY-2014-0003. Review. PubMed PMID: 25123728; PubMed Central PMCID: PMC4287068.