Family Medicine Practice Innovations Laboratory

The delivery of medical care is on the verge of a revolutionary transformation. The Internet and advances in information technology have provided the opportunity for the development of "virtual" medicine at a time when fiscal constraints provide constant pressure on physicians to find more cost-effective ways to deliver medical services.

The Department of Family Medicine is on the forefront of these developments by continuously innovating and evaluating its own practice. Our goal is to develop new knowledge about how to increase efficiency and effectiveness in family medicine practices and to disseminate that knowledge throughout the medical care system.

An example of practice innovation is the Virtual Specialty Consultation (VSC) program. This program, led by Dr. Steven Adamson, provides a mechanism for family medicine providers to obtain advice from other physicians without requiring a face-to-face visit between the patient and the specialist. Participation in the program is voluntary on the part of both patients and physicians.

Designing the Experiment

We will use a rigorous design to evaluate VSC program. During the first year, we will conduct telephone interviews of hundreds of patients and evaluate their satisfaction level. Some of the patients will have participated in the VSC program while others will have experienced face-to-face visits with a specialist. The satisfaction of patients will be compared in each group; we will also compare the satisfaction of patients who did not receive a specialist consultation.

As the evaluation builds momentum, overall self-rated health and clinical outcome measures (such as laboratory values) will be studied to see how the course of chronic diseases is different for patients receiving VSCs. In the second year of the evaluation, analysis will focus on comparisons of different chronic diseases to assess whether some types of patients are better served by VSCs than others.

A surveilance system created to monitor the impact of the VSC program will also be used to evaluate other practice innovations. For example, "open-access scheduling" has been adopted by the Department in an effort to increase responsiveness. How this change affects particular types of patients will be investigated. Different measures of the accessibility of care will be studied.

Evaluating the Results

When the results from the evaluations become available, we will write research reports and publish the findings. Our goal is to develop new knowledge about how to increase efficiency and effectiveness in family medicine practices and to disseminate that knowledge throughout the medical care system.