Patients receive better medical care when their primary care physicians (PCPs) and specialists work together as a team.  The fundamental purpose of our project is to improve teamwork between primary care providers and specialists.  Our goal is for every patient to receive the right care at the right time and in the right place.  


PCPs treat the vast majority of patients living with chronic illnesses. But PCPs face numerous challenges in their day-to-day work: too many patients, too little time, and too much trouble getting help from specialists.   


Collaboration between PCPs and specialists is hindered by unreliable referral systems (many patients fail to see the specialist), unclear division of responsibilities (which doctor is doing what?), and long wait times for specialist appointments.  Without good communication, patients see specialists both too early and too late.  In many cases, the medical problems addressed in face-to-face specialist visits could have just as easily been handled with an e-mail or a phone call.  Unnecessary specialist visits cost patients time and money, and delay care.  On the other hand, many patients are sent to specialists too late, after the window for prevention has already passed.


To address these challenges, we aim to:

            * Create a new collaboration between primary care providers and specialists that encourages teamwork and communication;

            * Give patients and physicians better and simpler options for specialty care;

            * Reduce the waiting time for specialist expertise; and

            * Improve population-level health for patients suffering from a common chronic illness


Our pilot project focuses specifically on chronic kidney disease (CKD).  Kidney disease is a common condition that is intertwined with other illnesses like diabetes and heart disease.  It is often under-diagnosed and under-treated.  The consequences of kidney failure are devastating for patients and very costly for health insurers.  Early treatment prevents or delays the need for dialysis, and it saves lives.


In partnership with Duke Primary Care and Duke Nephrology, we have launched an innovative pilot program in several primary care clinics that provides three main services:


            * CKD Help Desk.  We set up standardized treatment maps for primary care providers that suggest initial steps for chronic kidney disease evaluation and treatment.


            * E-consultations.  We provide PCPs free, easy access to a kidney specialist for advice through written “e-consults” to determine the need for further testing, treatment or in-person specialist referral.  


            * Analytics.  We use sophisticated electronic health record searches and risk prediction tools to find patients with severe kidney disease who need a particular treatment or who ought to see a specialist.


While our project focuses on kidney disease, we believe our approach and the lessons we learn will apply to a wide range of chronic medical conditions, such as congestive heart failure, diabetes, COPD, and many others.  We are conducting an analysis of the quality, cost and efficiency of the program that will help Duke University Health System leaders understand how a program like this could be deployed on a larger scale.