Research ArticleOriginal Research

Using the Quadruple Aim Framework to Measure Impact of Heath Technology Implementation: A Case Study of eConsult

Clare Liddy and Erin Keely
The Journal of the American Board of Family Medicine May 2018, 31 (3) 445-455; DOI: https://doi.org/10.3122/jabfm.2018.03.170397

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Example of a case submitted to a specialist via the Champlain Building Access to Specialists through eConsultation (BASE) eConsult service (details modified to ensure patient anonymity). PCP, principal care provider.

  • Figure 2.
    Figure 2.

    Number of eConsult cases completed per month and cumulatively.

  • Figure 3.
    Figure 3.

    The number of specialty groups available from the eConsult service by year.

  • Figure 4.
    Figure 4.

    The number of new principal care provider (PCPs) enrolled in the eConsult service by year.

Tables

  • Table 1.

    The Champlain Building Access to Specialists through eConsultation Service's Impact Viewed Through the Lens of the Quadruple Aim Framework

    AimOutcomeMeasureeConsult Impact
    Patient ExperienceWait timesUsage dataResponds to previously articulated patient dissatisfaction with wait times22
    Patient satisfactionInterviewsPatients deem useful in 86% of visits, acceptable alternative to traditional referrals in 97%23
    Response timeUsage dataMedian response time of 1.2 days (interquartile range, 0.2 to 4.2)
    Referral avoidanceUsage data71% of cases resolved without need of a face-to-face specialist referral
    Provider ExperiencePCP satisfactionCloseout surveyPCPs rank eConsult as high/very high value in 94% of cases25
    Educational valueCloseout survey92% of cases ranked as high/very high educational value.
    Specialist satisfactionSurveys94% of specialists report eConsult improves communication with PCPs26
    CostsTotal system costsCost dataTotal system costs over 2014 to 2015 fiscal year were $207,68027
    Per capita costCost dataWeighted average of $47.35/case versus $133.60/case for traditional referrals27
    Direct and indirect savingsEstimate of resource utilization, patient costs, etc.Accounting for societal factors (eg, avoided referrals and patient expenses) yields additional savings of $11/case28
    Population HealthHealth outcomes (eg, mortality, morbidity, and health status)Health administrative data, randomized controlled trialsUnable to assess
    Provider adoptionUsage data1299 PCPs have enrolled with the service
    Population servedUsage data28,838 cases completed, average monthly case volume increased from 13 in 2011 to 969 in 2017
    Provider utilizationUsage data61% of enrolled PCPs have used the service in the last 12 months
    Patient safetyUsage dataeConsult prompts a referral in 3.4% of cases, potentially improving patient safety31
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