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786. Improving Access by Prescreening Self-Referred Patients to an Infectious Disease Clinic

BACKGROUND: Studies show that 35% of patients obtaining care in a specialty clinic are self-referred, of these, 60% do not have a PCP. Frequent changing of physicians without provider referral contributes to high costs and healthcare inefficiencies. Many subspecialty clinics do not require provider...

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Autores principales: Saldana, Carlos S, Olender, Jeff, Gordon, Steven M, Holman, Katherine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6811314/
http://dx.doi.org/10.1093/ofid/ofz360.854
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author Saldana, Carlos S
Olender, Jeff
Gordon, Steven M
Holman, Katherine
author_facet Saldana, Carlos S
Olender, Jeff
Gordon, Steven M
Holman, Katherine
author_sort Saldana, Carlos S
collection PubMed
description BACKGROUND: Studies show that 35% of patients obtaining care in a specialty clinic are self-referred, of these, 60% do not have a PCP. Frequent changing of physicians without provider referral contributes to high costs and healthcare inefficiencies. Many subspecialty clinics do not require provider referral for access, so-called: ‘self-referral’; becoming an issue when patients discern a need for a subspecialty that does not align with their disease process. The Infectious Disease (ID) Department of the Cleveland Clinic Main Campus began prescreening all self-referred patients in July 2016. (Figure 1) We reviewed this process after sustained implementation. METHODS: Retrospective cohort study examining “self-referred” patients (lacking an internal referral order) to the ID Clinic from December 2016–October 2018. Grouped patients by chief complaint using system-based categories, subsequently reviewed records received for prior workup and identified if they had been seen by a specialist or received antibiotics in the past 6 months prior to visit. Those seen in our department were evaluated for: (1) additional workup ordered (2) if antibiotics were prescribed, and (3) referral to another specialty. RESULTS: 1449 patients self-referred. By prescreening them, waiting time for appointment fell from >40 to 13 days, no-shows steadily drop from 11% to 8%. We audit 105 (40%) of patients seen, most common reasons for referral: Skin 19 (18%), Bone/Joint 18 (17%), Concern for Lyme Disease 16 (15%). 73% had been previously seen by a subspecialty; majority by ID. 75% received antibiotics in the past 6 months. After the visit, 53% had new work up ordered, 21% were prescribed antibiotics and 26% patients were referred to another specialty. CONCLUSION: Prescreening self-referred patients contributed to improved access to subspecialty care and decreased”no-show’ appointments. The majority of self-referred patients had previous evaluation, frequently by the specialty being requested. [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68113142019-10-29 786. Improving Access by Prescreening Self-Referred Patients to an Infectious Disease Clinic Saldana, Carlos S Olender, Jeff Gordon, Steven M Holman, Katherine Open Forum Infect Dis Abstracts BACKGROUND: Studies show that 35% of patients obtaining care in a specialty clinic are self-referred, of these, 60% do not have a PCP. Frequent changing of physicians without provider referral contributes to high costs and healthcare inefficiencies. Many subspecialty clinics do not require provider referral for access, so-called: ‘self-referral’; becoming an issue when patients discern a need for a subspecialty that does not align with their disease process. The Infectious Disease (ID) Department of the Cleveland Clinic Main Campus began prescreening all self-referred patients in July 2016. (Figure 1) We reviewed this process after sustained implementation. METHODS: Retrospective cohort study examining “self-referred” patients (lacking an internal referral order) to the ID Clinic from December 2016–October 2018. Grouped patients by chief complaint using system-based categories, subsequently reviewed records received for prior workup and identified if they had been seen by a specialist or received antibiotics in the past 6 months prior to visit. Those seen in our department were evaluated for: (1) additional workup ordered (2) if antibiotics were prescribed, and (3) referral to another specialty. RESULTS: 1449 patients self-referred. By prescreening them, waiting time for appointment fell from >40 to 13 days, no-shows steadily drop from 11% to 8%. We audit 105 (40%) of patients seen, most common reasons for referral: Skin 19 (18%), Bone/Joint 18 (17%), Concern for Lyme Disease 16 (15%). 73% had been previously seen by a subspecialty; majority by ID. 75% received antibiotics in the past 6 months. After the visit, 53% had new work up ordered, 21% were prescribed antibiotics and 26% patients were referred to another specialty. CONCLUSION: Prescreening self-referred patients contributed to improved access to subspecialty care and decreased”no-show’ appointments. The majority of self-referred patients had previous evaluation, frequently by the specialty being requested. [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6811314/ http://dx.doi.org/10.1093/ofid/ofz360.854 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Saldana, Carlos S
Olender, Jeff
Gordon, Steven M
Holman, Katherine
786. Improving Access by Prescreening Self-Referred Patients to an Infectious Disease Clinic
title 786. Improving Access by Prescreening Self-Referred Patients to an Infectious Disease Clinic
title_full 786. Improving Access by Prescreening Self-Referred Patients to an Infectious Disease Clinic
title_fullStr 786. Improving Access by Prescreening Self-Referred Patients to an Infectious Disease Clinic
title_full_unstemmed 786. Improving Access by Prescreening Self-Referred Patients to an Infectious Disease Clinic
title_short 786. Improving Access by Prescreening Self-Referred Patients to an Infectious Disease Clinic
title_sort 786. improving access by prescreening self-referred patients to an infectious disease clinic
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6811314/
http://dx.doi.org/10.1093/ofid/ofz360.854
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