How Good Referral Pathways Impact Vascular and Overall Health - MedCity News - Latest Global News

How Good Referral Pathways Impact Vascular and Overall Health – MedCity News

Functional, standardized referral pathways can make or break patient outcomes. While this is true for general health, nowhere is it more evident than in vascular health, where many patients in need often fail to reach the right specialist, either because they are unaware that vascular specialists exist or because of a lack of standardized networks and connections between physicians. By understanding referral pathways and how we as physicians can contribute to them, we can fill gaps in the system and permanently improve patient outcomes.

How integrated and non-integrated systems influence referral pathways for vascular health

Put simply, a referral pathway is a case where a doctor, usually a GP, determines that a patient needs to be referred to a specialist for a particular problem. Sometimes the diagnosis is made by the GP, in other cases the entire care from diagnosis onwards is provided by the specialist.

In highly integrated systems like those at Mayo Clinic and Cleveland Clinic, where every provider has the same employer, every provider, and therefore every patient, is registered in the same electronic health record (EHR), making it easy for primary care physicians to identify specialists. For example, a primary care physician at Cleveland Clinic would expect to have an easy time identifying and referring a patient to a vascular surgeon, as the world-class hospital has a specialty vascular surgery department with more than 20 vascular surgeons on staff. This type of integration also allows primary care physicians to track their patients’ treatment, giving them clear insight into their health over time. Highly integrated healthcare systems like this are common in large cities and other urban areas, making it easy and often quick for patients to receive care. This simplicity and speed can make a significant difference to vascular health, as symptoms can develop within weeks or months or go undetected for years until a major problem arises.

Outside of urban areas—for example, in remote suburbs, rural, and isolated communities—PCPs are typically employed in non-integrated systems. In these cases, referrals are often based on different factors than in an integrated system. These factors may include personal knowledge of the specialist, perhaps they went to school or trained together. Or perhaps another provider in the same practice has an established relationship with a specialist and makes the recommendation. Essentially, it’s more relationship-based. That’s not to say the standard of care for patients in these non-integrated systems is less, but the referral pathway is less established and more haphazard, and can sometimes take longer, which can be problematic for patients who have just learned they have vascular disease.

Do current referral channels lead patients to the right specialists?

Although the goal is to match patients with the right provider for their needs, referring physicians often do not have real-time data to use to make this decision. This means that a referring physician typically has no way to quantitatively determine the quality of care patients receive from a particular specialist; it is all anecdotal and anecdotal. And when a patient does see a specialist, the referring physician may not know whether the patient is receiving guideline-based care or the appropriate or recommended care for their specific needs. Referring physicians must trust the specialist to whom they refer their patients.

However, there are criteria that primary care physicians and other doctors can use to determine at a glance whether a specialist is the right fit for their patient. In the area of ​​vascular health, for example, the specialist should have a residency in vascular surgery or vascular medicine. There are interventional radiology and interventional cardiology specialists who treat patients with vascular disease, but they should be able to demonstrate their commitment to vascular health by pursuing ongoing education in the area of ​​vascular disease, such as attending national vascular medicine conferences (especially as a speaker or presenter), participating in vascular research studies, scientific publications on vascular disease, and even community education programs. It can be helpful to look for specialists who are board-certified by the American Board of Venous and Lymphatic Medicine (for venous problems) or those who are Fellows of the Society for Vascular Surgery (for arterial and venous problems).

Where traditional transfer channels fail

Referral pathways typically fail due to a lack of awareness of the full spectrum of what specialists can do. This is especially true of vascular surgeons, for example, because they are not part of the scope of knowledge in medical school. In fact, most doctors can graduate from medical school and begin their postgraduate training programs without ever hearing about vascular surgery or what these specialists do for patients—namely, monitoring the health and function of the veins, arteries, and 60,000 miles of blood vessels in each patient’s body. This knowledge deficit can persist throughout a doctor’s career unless they happen to encounter a vascular surgeon treating a patient and then begin to understand what their skills really are.

Payers’ prior authorization timelines and processes can also have a significant impact on whether patients get to the right provider in a timely and safe manner, leading to alternative and less favorable treatment pathways.

Vascular surgery as a case study on the emergence of alternative referral routes

Although most patients are most commonly referred by a physician regardless of their condition, this is not the only route by which patients arrive at a specialist’s office. For patients receiving vascular treatment, referrals to urgent care and self-initiated referrals are also common, partly due to knowledge deficits in the medical field.

Urgent care referrals occur when a patient has an urgent or acute condition and ends up in an emergency room or urgent care facility. If the patient has experienced a health event involving an aortic aneurysm, blood clot, deep vein thrombosis (DVT), atherosclerosis, or other conditions or events related to the vascular system, they may be referred to a vascular surgeon at this time for specialized treatment.

Other patients initiate treatment themselves or rely on friends and family members. Self-initiated referrals often come from patients who have family members with vascular problems and want early or preventative treatment. Patients also often recommend treatment to their friends and family members if they are already under the care of a vascular surgeon, have had a good experience, and trust their doctor.

How we can improve referral pathways and contribute to better patient outcomes

Although some providers have established promising referral pathways, there is still much room for improvement. Whether a physician sends or receives the referral process, the speed of referrals needs to be increased so that patients can be seen without unnecessary delay. As with so many other conditions, patients with vascular disease often need to be seen within a matter of days or weeks, but current referral systems drag on for many weeks and months. This can create unnecessary risk and anxiety for patients who deserve compassionate care.

But what we need most is renewed and strengthened advocacy within the medical community to advocate for patients; a push for the urgent adoption of full interoperability in EHRs and a minimization of authorization requirements. These changes would create an environment where primary care physicians, specialists and patients can work together to ensure the best possible health outcomes, regardless of which referral route we choose.

Photo: Getty Images, pixelliebe


William P. Shutze, MD, is a board-certified vascular surgeon at Texas Vascular Associates in Dallas. He earned his medical degree from Baylor College of Medicine and completed his residency in general surgery at UAB Hospital, followed by a fellowship in vascular surgery at Baylor University Medical Center. Dr. Shutze has been actively involved in research, participating in over 25 clinical trials, authoring nearly 100 articles and abstracts, and presenting at over 90 conferences. He is a Fellow of the American College of Surgeons and a member of several prestigious medical societies. Dr. Shutze currently serves on the SVS Board of Directors as SVS Secretary.

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