When Delia Cooper made an appointment with her doctor to discuss her recurring sinus infections, she assumed the experience would be like others she had had – another MRI, a prescription for more antibiotics, but no end in sight to the chronic condition that was making her life miserable.
But this visit was different. This time, her family physician used the RACE line – short for Rapid Access to Consultative Expertise – to contact an Ear, Nose and Throat specialist who consulted on Cooper’s issue and helped get her off the medical merry-go-round and on a clear path to recovery.
“I had an appointment within a week, and this specialist wrote a wonderful letter and he referred me to another specialist who could actually help me,” says Cooper. “He used a new technique that addressed my problem both expediently and appropriately.”
RACE revs up access to specialty care
The RACE line connects family physicians and nurse practitioners with scheduled specialists from a variety of specialty services though a single phone call, or via electronic request sent through the RACE app. The specialists usually return the physician’s call within minutes and provide on-the-spot, expert advice about the medical condition in question, including whether or not the patient needs to be referred to see a specialist in person.
Dr. Andrew Ignaszewski, a cardiologist at Providence Health Care and the Head of the Department of Medicine, was one of the program’s founders. Prior to RACE, there were often communication delays between family doctors and specialists. “Sometimes the only way to get speedy information would be to catch someone in the hallway or in the doctors’ lounges. It was really inconsistent.”
RACE is reducing needless Emergency visits
In 2010, Providence created the prototype for RACE in an effort to improve access to specialty care in Vancouver. The initiative was led by Providence’s Margot Wilson and supported with funding from the Shared Care Committee (a partnership of Doctors of BC and the BC government).
Encouraging initial results showed positive feedback from physicians and patients alike, as well as a marked reduction in face–to-face specialist consults and unnecessary visits to the Emergency Department. Now offering more than 45 specialty areas, the RACE line has logged more than 50,000 consults since its inception, and an average of 1,000 calls per month.
“Often patients don’t need a full consultation, just a question or two answered, and that shortens my waitlist,” says Dr. Ignaszewski. “RACE is all about giving the right advice to the right patient at the right time.”
Dr. Joanne Yang, a family physician in Vancouver, began calling RACE in 2011 and now uses the RACE app to connect with specialists roughly six times a month. “I consult radiology and neurology most often. For example, I might have an additional question about a medical imaging result and I cannot get a hold of the original reading radiologist, so I will phone the radiologist on-call for the RACE line and get additional information.”
For family physicians, RACE enhances their ability to manage a patient’s care within their office and to create a plan of care that is both timely and specialist-informed.
“Specialists on-call for the RACE line have been uniformly helpful, knowledgeable and friendly,” says Dr. Yang. “The feedback I’ve received from my patients has been very positive. They feel reassured that I have sought a specialist’s opinion in complex or unusual situations.”
RACE model has spread across Canada
Following the key principles that the Vancouver RACE program created, the model began to spread to other areas of the province to help to address the unique contexts and needs of rural physicians and patients. By 2015 the RACE model had expanded across British Columbia to all five geographical health authorities.
In June 2017, the Canadian Foundation for Healthcare Improvement launched the Connected Medicine Collaborative the goal of spreading two leading Canadian innovations – RACE and Champlain BASE™ eConsult Service –nation-wide. The results of this program after 18 months show that more than half of the consults led to an appropriately avoided face-to-face referral to a specialist, and two in five consults led to an appropriately avoided emergency department visit.
“Working with the Canadian Foundation for Healthcare Improvement to spread RACE nationally was an amazing experience,” says Margot Wilson, Director, Shared Care & Virtual Health with Providence Health Care. “It’s a great thing for patients. If we can improve patient access to care for both rural and urban patients and simplify their health care journey, then we are headed in the right direction.”
Delia Cooper couldn’t agree more: “It changed my life for the better and I am able to sleep and breathe well at night again, so I have a lot more energy. This was the most stellar health care experience I have ever had in my life.”