PCLT Student Research Spotlight

Tuesday, December 5, 2017
By Priscille Schettini

As a PCLT student, I have had the opportunity to delve deeper into the topics of population health management throughout my medical education. During my second year, I engaged in 8 months of outpatient clinical training in Duke Primary Care (DPC) clinics and was introduced to the challenges of delivering optimal care in that setting. I wanted to use my third year research project as a way to gain a better understanding of the innovative health approaches that are addressing those barriers to patient care, particularly in chronic disease management. I received a scholarship from the Duke Institute for Health Innovation (DIHI) to work on one of their pilot projects. DIHI was an excellent way for me to connect with mentors who cared about population health and who were working at a systems level to promote change in health care delivery at Duke.  

I joined the DIHI team working on the “Building a Virtual Medical Neighborhood for Chronic Kidney Disease in Duke Primary Care (DPC)” project. This pilot program created a new partnership between DPC and Duke Nephrology to implement an electronic consultation program that allows PCPs to request recommendations from nephrologists through our electronic health record, EPIC, instead of sending traditional referrals. I evaluated the current state of referrals within DPC and assessed the impact of the eConsult program on timeliness of specialty care for our patients. My research found that eConsults improved closure of the specialty referral loop and dramatically shortened wait times for nephrology care. Our study supports the growing body of literature on eConsult programs and provides additional evidence that eConsults can reduce specialty referral demand and improve efficiency.

I helped to disseminate these findings with the goal of making the program sustainable and helped to promote its expansion to other subspecialties facing similar barriers to achieving better patient access to care. Our research was presented at several local and national conferences. The best part of my third year research experience was working with really supportive and energetic physician leaders, researchers, and students in the health innovation field. It was very exciting to see how quickly our research has spread to Duke Health leadership and how our work has the potential to impact change within our health system. This experience has given me the chance to think more broadly about how I can serve as a primary care provider while remaining involved in health innovation and research.