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Case Study

The Referral Coordination Team: A Redesign of Specialty Care to Enhance Service Delivery and Value in Sleep Medicine

Authors: Lucas M. Donovan, MD, MS, Brian N. Palen, MD, Laurie A. Fernandes, RN, Melanie D. Whittington, PhD, MS, William J. Feser, MS, Richard Blankenhorn, MS, Elise Gunzburger, MS, Gary K. Grunwald, PhD, Justina Gamache, MD, Joshua M. Liao, MD, MSc, Susan Kirsh, MD, MPH, and David H. Au, MD, MSAuthor Info & Affiliations
Published January 20, 2021
NEJM Catal Innov Care Deliv 2021;2(2)
DOI: 10.1056/CAT.20.0403
VOL. 2 NO. 2

Summary

Growing complexity in medical care has led to increased demand for specialized knowledge and services. Unfortunately, existing specialist capacity is insufficient, creating access limitations for vital services. VA Puget Sound Health Care System used a patient-centered approach to redesign specialty care delivery in the field of sleep medicine. Their redesign of referral management utilizes schedulers, nurses, and specialist providers at optimized skill levels to maximize team efficiency and service delivery. Their results suggest that this model improves timeliness, value across stakeholders, and patient experience while preserving the appropriateness of care.

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Notes

Lucas M. Donovan, Brian N. Palen, Laurie A. Fernandes, Melanie D. Whittington, William J. Feser, Richard Blankenthorn, Elise Gunzburger, Gary K. Grunwald, Justina Gamache, and Joshua M. Liao have nothing to disclose. Susan Kirsh and David H. Au report being employed by the VA Office of Veterans Access to Care during the conduct of the study. David H. Au reports personal fees from Novartis for service on a data monitoring committee, personal fees from the American Board of Internal Medicine for service on the examination writing committee, and personal fees from Annals of the American Thoracic Society for service as a deputy editor, outside the submitted work. Funding was provided by the Office of Veteran’s Access to Care; Seattle-Denver Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA; and VA Health Services Research & Development Career Development Award CDA-18-187. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Information & Authors

Information

Published In

NEJM Catalyst Innovations in Care Delivery
Volume 2 • Number 2 • January 20, 2021

Copyright

Copyright © 2021 Massachusetts Medical Society.

History

Published online: January 20, 2021
Published in issue: January 20, 2021

Topics

  1. Care Coordination
  2. Patient Experience
  3. Patient Incentives
  4. Specialty Care
  5. Team-Based Care

Authors

Affiliations

Lucas M. Donovan, MD, MS
Core Investigator, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
Assistant Professor of Medicine, University of Washington, Seattle, Washington, USA
Brian N. Palen, MD
Director of Sleep Medicine, VA Puget Sound Health Care System, Seattle, Washington, USA
Associate Professor of Medicine, University of Washington, Seattle, Washington, USA
Laurie A. Fernandes, RN
Community Care Chief, VA Northwest Network (VISN 20), Vancouver, Washington, USA
Melanie D. Whittington, PhD, MS
Associate Director of Health Economics, Institute for Clinical and Economic Review, Boston, Massachusetts, USA
William J. Feser, MS
Biostatistician, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado, USA
Richard Blankenhorn, MS
Biostatistician, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado, USA
Elise Gunzburger, MS
Biostatistician, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado, USA
Gary K. Grunwald, PhD
Professor, Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
Justina Gamache, MD
Clinical Director of VISN20 Referral Coordination Program, VA Puget Sound Health Care System, Seattle, Washington, USA
Clinical Instructor of Medicine, University of Washington, Seattle, Washington, USA
Joshua M. Liao, MD, MSc
Associate Professor of Medicine, University of Washington, Seattle, Washington, USA
Medical Director for Payment Strategy, University of Washington, Seattle, Washington, USA
Director, Value & Systems Science Lab, Seattle, Washington, USA
Susan Kirsh, MD, MPH
Acting Assistant Deputy Under Secretary for Health for Access to Care, Office of Veterans Access to Care, Veterans Health Administration, Washington, DC, USA
David H. Au, MD, MS
Director, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
Professor of Medicine, University of Washington, Seattle, Washington, USA

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