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Over the past decade, the use of subspecialty medical services has risen rapidly in the United States, with referrals to specialists more than doubling. Along with the increasing referral rates, there is a decrease in communication and coordination between primary care providers (PCPs) and specialists. Patients are faced with poor access to specialists, high costs, and fragmented care. At the same time, academic medical centers (AMCs) are shifting their care-delivery models from volume-based care to value-based care. New, innovative models are needed to meet these changes in care delivery and payment while ensuring high-quality, high-value care delivery to patients.
Project CORE: Coordinating Optimal Referral Experiences―Implementing eConsults and Enhanced Referrals, aims to improve quality of care and the patient experience while reducing the overall cost of care by enhancing communication and coordination between primary care and specialty physicians. Through the CORE model, developed and piloted at the University of California, San Francisco (UCSF),
- Patients will have improved access to care with fewer unnecessary tests and visits;
- Primary care physicians will receive timely input and expertise from specialists clearly and succinctly documented in the electronic medical record (EMR); and
- Specialists will receive clear clinical questions with necessary pre-referral evaluation completed, providing more efficient referrals.
Project CORE uses EMR-based tools, known as eConsults and enhanced referrals. These decision-support tools enhance clinical workflows, thereby improving communication and care coordination between primary care and specialist providers.
In 2014, the AAMC received funding from the Center for Medicare and Medicaid Innovation (CMMI) to partner with UCSF and others to implement and evaluate Project CORE across five AMCs:
2. University of California, San Diego Medical Center
3. University of Iowa Hospitals and Clinics
4. University of Virginia Medical Center
5. University of Wisconsin (UW) Health
To learn more about the CMMI collaborative and the program's objectives, please read the Project CORE overview .
Based on a commitment to further scale this innovation to improve quality of ambulatory care, the AAMC is leading a second cohort of seven additional AMCs in 2016 to implement the CORE model:
1. ECU Physicians
2. Greenville Health System
3. Ohio State University
4. University of Michigan
5. University of Washington Medicine
6. Vidant Health
7. Wake Forest Baptist Health
- Review recent research on eConsults and eReferrals
- Advancing the Primary/Specialty Care Interface Through eConsults and Enhanced Referrals. Davis A, Gilchrist V, Grumbach K, James P, Kallenberg R, Shipman SA. Ann Fam Med. 2015 July;13(4):387-9.
- When to Repatriate? Clinicians' Perspectives on the Transfer of Patient Management from Specialty to Primary Care. Ackerman SL1, Gleason N, Monacelli J, Collado D, Wang M, Ho C, Catschegn-Pfab S, Gonzales R. J Gen Intern Med. 2014 Jun 17.
- eReferral -- A New Model for Integrated Care. Chen AH1, Murphy EJ, Yee HF Jr. N Engl J Med. 2013 Jun 27;368(26):2450-3.
Review recent researchon eConsults and eReferrals!
Scott Shipman, MD, MPH
Director of Primary Care Affairs and Workforce
Meaghan Quinn, MHSA
CORE Program Manager, Health Care Affairs
CORE Program Specialist
Danielle Carder, MSc
Project CORE Program Specialist