Using behavioral economics, the study objective is to increase the efficiency, quality, and timeliness of care for Los Angeles County (LAC) Department of Health Services (DHS) patients by nudging specialists toward more effective use of eConsult, a web-based consultation and communication portal for Primary Care Providers (PCPs) and specialists, improving access for patients in greatest need of specialty care.
Historically, the Los Angeles County (LAC) Department of Health Services (DHS) Safety Net system has faced challenges in delivering specialty services that are timely, geographically equitable, and coordinated in a patient centered manner. Recently, LACDHS improved infrastructure through implementation of eConsult, a web-based consultation and communication portal for Primary Care Providers (PCPs) and specialists, improving access for patients in greatest need of specialty care. The study investigators will conduct a pragmatic randomized trial with the goal of increasing the efficiency, quality, and timeliness of care for LACDHS patients by nudging specialists toward more effective use of eConsult. If successful, these nudges may reduce the number and increase the value of face-to-face consults.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
220
eConsult Specialty Reviewers are asked to rate the quality of other specialists' recently completed eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)
eConsult Specialty Reviewers receive confidential feedback via email on their performance (top performer vs not a top performer) as compared to colleagues in their specialty. Feedback is based on other reviewers ratings of their eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)
Los Angeles County Department of Health Services
Los Angeles, California, United States
Rating - Medical Decision Making
Peers' ratings of Medical Decision Making in Specialists' responses to PCPs
Time frame: Baseline to Post-Intervention, up to 12 months
Rating - Application of Expected Practices
Peers' ratings of Expected Practices in Specialists' responses to PCPs
Time frame: Baseline to Post-Intervention, up to 12 months
Rating - Relationship Building
Peers' ratings Relationship Building in Specialists' responses to PCPs
Time frame: Baseline to Post-Intervention, up to 12 months
Rating - Expert Elicitation
Peers' ratings of Specialists' skill in elicitation of information from PCPs
Time frame: Baseline to Post-Intervention, up to 12 months
Rating - Educational Value
Peers' ratings of Educational Value of eConsults
Time frame: Baseline to Post-Intervention, up to 12 months
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