CLINICAL NEWS
ASH® | Awards
Clinical Characteristics of Study Participants Based
on Trial Implementation
TABLE 3.
Median age (years)
e-Consults
(n=302)
Face-to-face consults
prior to e-Consult
implementation
(n=305)
Face-to-face consults
after e-Consult
implementation
(n=302)
p Value
64
69.3
65.92
<0.001
Diagnosis
Anemia
64 (21%)
103 (34%)
63 (21%)
<0.001
Thrombocytopenia
28 (9%)
34 (11%)
38 (13%)
0.419
Leukocytosis
31 (10%)
19 (6%)
28 (9%)
0.183
Neutropenia
18 (6%)
11 (4%)
14 (5%)
0.397
Paraprotein
23 (8%)
26 (9%)
15 (5%)
0.231
VTE
38 (13%)
17 (6%)
36 (12%)
0.005
Time to completion (days)
13.25
29.36
31.39
<0.001
Distance from clinic (miles)
37.56
33.04
33.77
0.017
VTE = venous thromboembolism
clinicians, and guidelines called ‘service
agreements’ were developed with the
primary-care leadership to help referring
clinicians determine which clinical issues
were appropriate for each type of consult,”
Dr. Cecchini and co-authors wrote.
After referrals were made, hematologists reviewed the EMR, peripheral blood
smear, and imaging (when appropriate),
and then recommended medical care in
the patient’s EMR. The hematologist was
able to recommend additional testing and/
or a face-to-face visit referral, which the
referring clinician would then communicate back to the patient.
The authors noted that VA EMRs
are especially comprehensive, including
data on problem lists, pharmacy records,
laboratory data imaging, and all provider
visits, which helped to enhance the results
of this study.
The researchers randomly selected 302
e-Consults, 305 face-to-face consults prior
to e-Consult implementation, and 302
face-to-face consults after the implementation of e-Consult. The most common
reason for consultation was anemia, and
the majority of these cases were benign
disease or presumed early myelodysplastic syndromes. See TABLE 3 for more on
patient characteristics.
E-Consults were converted to face-toface consults in 17 percent of study cases.
Patients who received e-Consults had
more timely evaluations and lived further
from the clinic than patients who had
face-to-face consults (TABLE 3).
The majority of coagulation-related eConsults were related to the management
of venous thromboembolism, with a few
cases attributed to atrial fibrillation and
von Willebrand disease.
Dr. Cecchini and co-authors also measured patient and