Enhancing Community-Based Specialty Access Through Virtual Care

Abstract

In December 2020, the authors set out to improve access to tertiary care at Henry Ford Health by creating a network of virtual care clinics to overcome the challenges of home-based virtual care, including broadband access or the need for physical examination. These clinics provided connectivity to the tertiary specialist, vital sign assessment, physical examination, and facilitation of diagnostic testing at a location convenient to the patient. Each clinic was staffed by an on-site team including medical assistants and a single advanced practice provider; the tertiary specialists were present only virtually. For example, a patient with complex Crohn’s disease requiring surgery and parenteral nutrition is best served by a tertiary specialist and multidisciplinary team. These patients require frequent, thorough follow-up visits, including blood pressure checks to assess hydration, catheter site checks, and physical examination to assess healing after surgery, in addition to medical management of Crohn’s disease by a tertiary specialist. Each of these parameters is clinically paramount and not optimally assessed during a home-based video visit. In this clinical scenario, the medical assistant telepresented the patient to the off-site specialist, checked vital signs, and showed the specialist the catheter and surgical site. The clinical consultation took place in the local clinic facility, with the support of the on-site team. Laboratory testing and imaging studies were coordinated through community settings, and tertiary site–based surgical, health psychology, and nutritional teams also followed up with this patient via virtual care clinic visits. By providing these clinical services closer to the patient’s home through a clinical facility, numerous objectives were achieved: (1) patients received thorough clinical assessment and care plans; (2) patients were less likely to use the hospital or ED; (3) patients were more likely to remain in the workforce; and (4) community health care was off-loaded, reducing burnout and improving workforce retention. This approach combines virtual care with a cooperative care delivery model, where the aim is not to shift patient care from one provider to another, but to expand access for patients and to create both new and clinically appropriate care for each care participant, with the aim that improved access will lead to enhanced care outcomes and more efficient care utilization. Telemedicine endeavors have increased dramatically in the past few years, and to the best of the authors’ knowledge, no other health system or hospital has expanded specialty services into rural communities in this collaborative manner. The novel approach to health care delivery outlined herein provides a model to improve access to specialty care and patient outcomes, and could be replicated in other regions. Collaboration across institutions, cooperation among leaders and physicians, and commitment to serve communities are the keys to success.