Rapid Access to Consultative Expertise (RACE)

Margot Wilson

2

Joint partnership between Providence Health Care and the

Shared Care Committee in collaboration with Vancouver

Coastal Health (VCH)

Mission to improve care for patients with complex chronic conditions

Simplify the patient journey

Improve outcomes

Reduce costs

Strengthen relationships

Background

3

Focus groups

bullFamily physicians

bullSpecialists

bullPatients

Need for improved

bullCommunication

bullAccess to specialists

bullCollaboration and relationships

4

One phone line with a selection of

specialty services

Started in June 2010 with five

services

Currently at 18 services with plans to

increase

Rapid Access to Consultative Expertise (RACE)

httpwwwyoutubecomwatchv=TQyKe0CKh_A

2

Joint partnership between Providence Health Care and the

Shared Care Committee in collaboration with Vancouver

Coastal Health (VCH)

Mission to improve care for patients with complex chronic conditions

Simplify the patient journey

Improve outcomes

Reduce costs

Strengthen relationships

Background

3

Focus groups

bullFamily physicians

bullSpecialists

bullPatients

Need for improved

bullCommunication

bullAccess to specialists

bullCollaboration and relationships

4

One phone line with a selection of

specialty services

Started in June 2010 with five

services

Currently at 18 services with plans to

increase

Rapid Access to Consultative Expertise (RACE)

httpwwwyoutubecomwatchv=TQyKe0CKh_A

3

Focus groups

bullFamily physicians

bullSpecialists

bullPatients

Need for improved

bullCommunication

bullAccess to specialists

bullCollaboration and relationships

4

One phone line with a selection of

specialty services

Started in June 2010 with five

services

Currently at 18 services with plans to

increase

Rapid Access to Consultative Expertise (RACE)

httpwwwyoutubecomwatchv=TQyKe0CKh_A

4

One phone line with a selection of

specialty services

Started in June 2010 with five

services

Currently at 18 services with plans to

increase

Rapid Access to Consultative Expertise (RACE)

httpwwwyoutubecomwatchv=TQyKe0CKh_A

5

VCH

Nephrology

Heart failure

Psychiatry

Respirology

Endocrinology

Cardiovascular risk amp lipid

management

General internal medicine

Geriatrics

Gastroenterology

Geriatric psychiatry

Addictions medicine

Current services

VCH amp Fraser Heatlh

Cardiology

Rheumatology

Provincial Services

Child amp adolescent psychiatry

Chronic pain

Treatment-resistant psychosis

HIV primary care

Transgender primary care

6

Phase 1 ndash questionnaireinterviews

ldquoExcellent resourcerdquo

ldquoWould like to see it expandedrdquo

Viewed as a service that could ldquohellipfill the gaphelliprdquo

Phase 2 ndash online survey

High user satisfaction ndash all would use the service again 95 recommend

usage to colleagues

All FPs noted that RACE

Reduced the number of unnecessary referrals to specialist care

Prevented ED visits

Phase 3 ndash In progress - Interviewssurvey

83 of respondents believed it helped manage care for their patients

Evaluation key themes

7

Provides a user-friendly ldquodecision support systemrdquo

Improves clinical judgment

Provides medical education

Increases knowledge capacity

Enhances overall practice efficiencies

How RACE impacts practice

Results and outcomes

(gt8000 calls data based on 30 of

calls)

80 of calls answered within 10 mins

90 are lt15 mins in length

60 avoided face-to-face consults

32 avoided ED visits

Reason for call

General management diagnostic

therapeutics

Recommendation

Medication additional testing

reassurance of plan

Cost savings ndash up to $200call

Improved patient and provider

experience

Improved efficiencies

Improved ED flow

Increased specialist capacity

9

Key learnings from RACE

One size does not fit all

Care to avoid replacing well-established effective communication lines

No disruption of referral patterns

Requires criteria for specialist participation

Response time collegial interaction knowledge transfer

Requires limited resources

Coordination of schedulesre-routing numbers

Medical Services Plan billing code

Patient participation was key in the design

Keep it simple

Be responsive

Use marketing to get the word out

10

Current RACE line

Northern Partners in Care ndash telephone advice line

Surrey North Delta Division of Family Practice advice line

exploration

South Island Division of Family Practice interest

Current status - Provincial telephone advice

11

ldquohellipIt is fantastic to be able to get answers immediately that I normally would either Refer to a specialist and have to wait months for an

appointment Try and look up online but not be confident of the answer Play telephone tag or fax back and forth with a specialist

regarding the clinical situation Just take my best guess with the clinical situation It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

12

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

13

RACE has the potential to Enhance the care experience by

Providing knowledge transfer Improving the specialistprimary

care interface through improved communication

Simplifying the patient journey

Improve population health Access to care is enhanced

Lower per capita cost of health care

Or at least control avoidable consults and emergency visits

Summary

RACE online resources and information

bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

6

Phase 1 ndash questionnaireinterviews

ldquoExcellent resourcerdquo

ldquoWould like to see it expandedrdquo

Viewed as a service that could ldquohellipfill the gaphelliprdquo

Phase 2 ndash online survey

High user satisfaction ndash all would use the service again 95 recommend

usage to colleagues

All FPs noted that RACE

Reduced the number of unnecessary referrals to specialist care

Prevented ED visits

Phase 3 ndash In progress - Interviewssurvey

83 of respondents believed it helped manage care for their patients

Evaluation key themes

7

Provides a user-friendly ldquodecision support systemrdquo

Improves clinical judgment

Provides medical education

Increases knowledge capacity

Enhances overall practice efficiencies

How RACE impacts practice

Results and outcomes

(gt8000 calls data based on 30 of

calls)

80 of calls answered within 10 mins

90 are lt15 mins in length

60 avoided face-to-face consults

32 avoided ED visits

Reason for call

General management diagnostic

therapeutics

Recommendation

Medication additional testing

reassurance of plan

Cost savings ndash up to $200call

Improved patient and provider

experience

Improved efficiencies

Improved ED flow

Increased specialist capacity

9

Key learnings from RACE

One size does not fit all

Care to avoid replacing well-established effective communication lines

No disruption of referral patterns

Requires criteria for specialist participation

Response time collegial interaction knowledge transfer

Requires limited resources

Coordination of schedulesre-routing numbers

Medical Services Plan billing code

Patient participation was key in the design

Keep it simple

Be responsive

Use marketing to get the word out

10

Current RACE line

Northern Partners in Care ndash telephone advice line

Surrey North Delta Division of Family Practice advice line

exploration

South Island Division of Family Practice interest

Current status - Provincial telephone advice

11

ldquohellipIt is fantastic to be able to get answers immediately that I normally would either Refer to a specialist and have to wait months for an

appointment Try and look up online but not be confident of the answer Play telephone tag or fax back and forth with a specialist

regarding the clinical situation Just take my best guess with the clinical situation It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

12

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

13

RACE has the potential to Enhance the care experience by

Providing knowledge transfer Improving the specialistprimary

care interface through improved communication

Simplifying the patient journey

Improve population health Access to care is enhanced

Lower per capita cost of health care

Or at least control avoidable consults and emergency visits

Summary

RACE online resources and information

bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

7

Provides a user-friendly ldquodecision support systemrdquo

Improves clinical judgment

Provides medical education

Increases knowledge capacity

Enhances overall practice efficiencies

How RACE impacts practice

Results and outcomes

(gt8000 calls data based on 30 of

calls)

80 of calls answered within 10 mins

90 are lt15 mins in length

60 avoided face-to-face consults

32 avoided ED visits

Reason for call

General management diagnostic

therapeutics

Recommendation

Medication additional testing

reassurance of plan

Cost savings ndash up to $200call

Improved patient and provider

experience

Improved efficiencies

Improved ED flow

Increased specialist capacity

9

Key learnings from RACE

One size does not fit all

Care to avoid replacing well-established effective communication lines

No disruption of referral patterns

Requires criteria for specialist participation

Response time collegial interaction knowledge transfer

Requires limited resources

Coordination of schedulesre-routing numbers

Medical Services Plan billing code

Patient participation was key in the design

Keep it simple

Be responsive

Use marketing to get the word out

10

Current RACE line

Northern Partners in Care ndash telephone advice line

Surrey North Delta Division of Family Practice advice line

exploration

South Island Division of Family Practice interest

Current status - Provincial telephone advice

11

ldquohellipIt is fantastic to be able to get answers immediately that I normally would either Refer to a specialist and have to wait months for an

appointment Try and look up online but not be confident of the answer Play telephone tag or fax back and forth with a specialist

regarding the clinical situation Just take my best guess with the clinical situation It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

12

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

13

RACE has the potential to Enhance the care experience by

Providing knowledge transfer Improving the specialistprimary

care interface through improved communication

Simplifying the patient journey

Improve population health Access to care is enhanced

Lower per capita cost of health care

Or at least control avoidable consults and emergency visits

Summary

RACE online resources and information

bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

Results and outcomes

(gt8000 calls data based on 30 of

calls)

80 of calls answered within 10 mins

90 are lt15 mins in length

60 avoided face-to-face consults

32 avoided ED visits

Reason for call

General management diagnostic

therapeutics

Recommendation

Medication additional testing

reassurance of plan

Cost savings ndash up to $200call

Improved patient and provider

experience

Improved efficiencies

Improved ED flow

Increased specialist capacity

9

Key learnings from RACE

One size does not fit all

Care to avoid replacing well-established effective communication lines

No disruption of referral patterns

Requires criteria for specialist participation

Response time collegial interaction knowledge transfer

Requires limited resources

Coordination of schedulesre-routing numbers

Medical Services Plan billing code

Patient participation was key in the design

Keep it simple

Be responsive

Use marketing to get the word out

10

Current RACE line

Northern Partners in Care ndash telephone advice line

Surrey North Delta Division of Family Practice advice line

exploration

South Island Division of Family Practice interest

Current status - Provincial telephone advice

11

ldquohellipIt is fantastic to be able to get answers immediately that I normally would either Refer to a specialist and have to wait months for an

appointment Try and look up online but not be confident of the answer Play telephone tag or fax back and forth with a specialist

regarding the clinical situation Just take my best guess with the clinical situation It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

12

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

13

RACE has the potential to Enhance the care experience by

Providing knowledge transfer Improving the specialistprimary

care interface through improved communication

Simplifying the patient journey

Improve population health Access to care is enhanced

Lower per capita cost of health care

Or at least control avoidable consults and emergency visits

Summary

RACE online resources and information

bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

9

Key learnings from RACE

One size does not fit all

Care to avoid replacing well-established effective communication lines

No disruption of referral patterns

Requires criteria for specialist participation

Response time collegial interaction knowledge transfer

Requires limited resources

Coordination of schedulesre-routing numbers

Medical Services Plan billing code

Patient participation was key in the design

Keep it simple

Be responsive

Use marketing to get the word out

10

Current RACE line

Northern Partners in Care ndash telephone advice line

Surrey North Delta Division of Family Practice advice line

exploration

South Island Division of Family Practice interest

Current status - Provincial telephone advice

11

ldquohellipIt is fantastic to be able to get answers immediately that I normally would either Refer to a specialist and have to wait months for an

appointment Try and look up online but not be confident of the answer Play telephone tag or fax back and forth with a specialist

regarding the clinical situation Just take my best guess with the clinical situation It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

12

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

13

RACE has the potential to Enhance the care experience by

Providing knowledge transfer Improving the specialistprimary

care interface through improved communication

Simplifying the patient journey

Improve population health Access to care is enhanced

Lower per capita cost of health care

Or at least control avoidable consults and emergency visits

Summary

RACE online resources and information

bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

10

Current RACE line

Northern Partners in Care ndash telephone advice line

Surrey North Delta Division of Family Practice advice line

exploration

South Island Division of Family Practice interest

Current status - Provincial telephone advice

11

ldquohellipIt is fantastic to be able to get answers immediately that I normally would either Refer to a specialist and have to wait months for an

appointment Try and look up online but not be confident of the answer Play telephone tag or fax back and forth with a specialist

regarding the clinical situation Just take my best guess with the clinical situation It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

12

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

13

RACE has the potential to Enhance the care experience by

Providing knowledge transfer Improving the specialistprimary

care interface through improved communication

Simplifying the patient journey

Improve population health Access to care is enhanced

Lower per capita cost of health care

Or at least control avoidable consults and emergency visits

Summary

RACE online resources and information

bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

11

ldquohellipIt is fantastic to be able to get answers immediately that I normally would either Refer to a specialist and have to wait months for an

appointment Try and look up online but not be confident of the answer Play telephone tag or fax back and forth with a specialist

regarding the clinical situation Just take my best guess with the clinical situation It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

12

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

13

RACE has the potential to Enhance the care experience by

Providing knowledge transfer Improving the specialistprimary

care interface through improved communication

Simplifying the patient journey

Improve population health Access to care is enhanced

Lower per capita cost of health care

Or at least control avoidable consults and emergency visits

Summary

RACE online resources and information

bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

12

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

13

RACE has the potential to Enhance the care experience by

Providing knowledge transfer Improving the specialistprimary

care interface through improved communication

Simplifying the patient journey

Improve population health Access to care is enhanced

Lower per capita cost of health care

Or at least control avoidable consults and emergency visits

Summary

RACE online resources and information

bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

13

RACE has the potential to Enhance the care experience by

Providing knowledge transfer Improving the specialistprimary

care interface through improved communication

Simplifying the patient journey

Improve population health Access to care is enhanced

Lower per capita cost of health care

Or at least control avoidable consults and emergency visits

Summary

RACE online resources and information

bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

RACE online resources and information

bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

wwwRACEconnectca

Margot Wilson mwilsonprovidencehealthbcca

For more information Shared Care Committee

115 - 1665 West Broadway Vancouver BC V6J 5A4

Tel 604 736-5551 wwwbcmaorg

Margot Wilson mwilsonprovidencehealthbcca

17

What do you think is critical to maintain in spreading a

model of telephone advice provincially

Write two to three of your top recommendations on a Post-it

note

Input and advice

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17