Specialty: Urology, Primary Care

Keywords: eConsult, Access to Care, Safety Net

Background: To maximize access to urologic care, the Los Angeles County Department of Health Services (LAC- DHS)—the second-largest U.S. public health system—pursued clinical integration through primary care empanelment, asynchronous eConsult, and Specialty-Primary Care Workgroups that derive Expected Practices (EPs, population-specific clinical algorithms). eConsult allows communication, consult forwarding across LAC-DHS, and timeframe recommendations for when a patient should be seen. “Precision Scheduling” measures whether a patient is seen within that timeframe.

Objective: We evaluated how eConsult-integrated care affected access to urologic services in the safety net. We hypothesized that integrated care would allow improved precision scheduling over time, and that a significant proportion of patient needs could be addressed without a face-to-face urology visit.

Methods: We prospectively assessed eConsults within LAC-DHS from January 2021 to October 2024. We defined precision scheduling as the proportion of patients seen within the timeframe recommended by the urologic reviewer. We measured eConsult volume, reviewer response time, eConsult forwarding, and final addressing of patient needs (face-to-face visit versus “non-face-to-face specialty-care touch” [NFTFSCT, resolved with urology input but without a face-to-face visit]). We compared patient characteristics by precision scheduling, and conducted a multivariate logistic regression to identify sociodemographic and clinical factors associated with precision scheduling.

Results: Precision scheduling improved steadily over time, approaching 90% for most of 2024 (Figure 1). Of 22,425 urology eConsults, patient needs were met in 22% of cases with NFTFSCT. Average reviewer response time was 3.7 days, and eConsults were forwarded in 8% of cases. We identified opportunities to improve access for patients with urgent needs (2-4 weeks) (Table 1), even after controlling for age, race, and insurance status.

Conclusions: In the largest eConsult experience in the U.S., eConsult-integrated care improved access by enabling real-time resource allocation across a large, complex health system. Within an integrated system, eConsult maximizes specialists’ capacity to serve large populations.

Supplementary Figures