703 - Overcoming Specialty Care Connection Barriers: The EConsultation Effect

Genevieve Whiting, The Barbara Bush Children's Hospital at Maine Medical Center, Cape Elizabeth, ME, United States; Noah Hoffman, MaineHealth, Portland, ME, United States; Anya Cutler, MaineHealth Institute for Research, Montpelier, VT, United States; Leah Marie Seften, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States; Laura J. Faherty, Maine Medical Center/RAND, Cape Elizabeth, ME, United States

Background: Up to half of pediatric specialty referrals in the US fail to result in an in-person visit. Patients in rural communities are among the least likely to connect and have poorer health outcomes, suggesting greater unmet needs. eConsults - asynchronous, patient-specific, primary-specialty care communications - facilitate primary care management of and minimize access barriers for patients with a subset of clinical concerns that benefit from specialist input. Specialist face-to-face (F2F) evaluation remains necessary for most patients requiring specialist input. Thus, increasing care connection after referral is essential to improving outcomes and reducing disparities.

Objective: This study evaluates whether a referral resulting from a converted eConsult (eConsult not completed, specialist recommends F2F referral), improves specialty connection rates at MaineHealth, the largest pediatric referral center in Maine.

Design/Methods: This retrospective cohort study analyzed data from subjects less than 18 years old referred to Pediatric Endocrinology, Gastroenterology and Nephrology at MaineHealth over distinct time periods pre- and post-eConsult implementation from February-July 2021 (control group) and February 2022-April 2024 (exposure group). The primary outcome was a specialist visit following referral. Logistic regression was used to determine the odds ratio of a specialist visit following a standard primary-specialty care referral in the pre-eConsult era to a visit following a converted eConsult with associated referral in the post-econsult era. Subsequent logistic regression models tested the interaction terms between referral type (standard vs. converted eConsult) and rurality, Childhood Opportunity Index (COI), or driving time.

Results: The odds of attending a specialist visit following a converted eConsult was 2.55 times higher than for standard F2F referrals (95% CI = 1.46, 4.78; p = 0.002). There was no significant interaction between referral type and rurality, COI, or driving time greater than 60 minutes.

Conclusion(s): Patients referred following a converted eConsult have significantly higher odds of connecting with a specialist than those with standard referrals. Our study was underpowered to detect a significant interaction with rurality, COI or drive time. eConsults aim to reduce barriers to accessing specialist input. For patients who require F2F evaluation, a converted eConsult may affirm the value of seeking specialty care and encourage families to attend the visit, if able. This increased connection rate may reduce unmet needs and improve outcomes.

Percentage of Referrals Resulting in a Face-to-Face (F2F) Specialist Visit for 548 standard F2F Referrals and 121 Converted eConsults
Rural Urban Commuting Area (RUCA) Code Category- Dichotomized Urban= RUCA Code 1; Rural= RUCA Codes 2-10;
Childhood Opportunity Index (COI)- Dichotomized into Very Low-Moderate COI and High-Very High COI;
Driving Time- Calculated for the centroid of each patient zip code to the Maine Medical Center campus using the zipcodeR and gmapsdistance packages in R