Background/Purpose: In the context of the rheumatology workforce shortage, eConsultation holds significant potential to address some challenges through supporting primary care providers in managing rheumatologic conditions. Gout is a useful prototype for implementation of eConsults considering uric acid as a biomarker, the common nature of gout, and well-defined treatment regimens. This quality improvement project aimed to evaluate the current impact of gout eConsults on improvements in uric acid, consistency of consultation, conversion to in-person visits, and milage and travel cost savings.

Methods: Data from 93 gout consults received between 5/18/2018 – 9/16/2024 at a single academic site were reviewed. Data was collected regarding uric acid levels, the type of recommendation provided, as well as whether the patient was seen in-person by rheumatology. Consults were categorized based on whether patients were evaluated with eConsult only, immediately converted to in-person visit, or subsequently converted to an in-person visit. Duplicate eConsults and patients who were never seen due to cancellations or scheduling errors were excluded from analysis. Milage saved and travel cost saved were calculated based on the distance between the patient’s zip code and the medical center and the average IRS milage compensation from 2018-2024 ($0.599/mile).

Results: Forty-nine eConsults did not require an in-person visit.Twenty-five patients were converted to an initial in-person visit. Six additional patients were subsequently converted to an in-person visit. Average uric acid levels decreased over the monitoring period in patients treated by all three pathways (Table 1). Patients triaged to in-person visits compared to eConsult generally had a higher baseline uric acid level (8.2 versus 7.9), but lower levels (5.1 versus 6.0) at 1 year. Average 2-way milage saved for patients with eConsult was 45.6 miles. Average cost savings was $27.31 (Figure 1). Formal categorization of qualitative data was not performed for this quality improvement study. However, there was notable heterogeneity in responses, such as interval of checking uric acid. Limitations include missing values for uric acid.

Conclusion: eConsults resulted in decreased uric acid from baseline as well as both mileage and travel cost savings for patients. Though there were likely intrinsic differences between in-person and eConsult patient populations at baseline, the lower uric acid levels with in-person visits suggest there is room for improvement with current eConsultation practices. Future quality improvement directions include: standardization of gout eConsult recommendations utilizing tools such as a division-wide consult smart phrases, point-of-care treatment algorithms for referring clinicians such as in Figure 2, and pairing of eConsults with other care-delivery models such as pharmacy or nursing-led gout clinics. Analysis of cost savings and milage savings represent unique metrics for monitoring quality improvement.

Table 1: Change in uric acid over time for eConsultation and in-person visits

Figure 1: Travel distance (2-way) and associated travel costs for patients

Figure 2: Schematic for point-of-care diagnostic and therapeutic algorithm

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/bridging-the-gap-leveraging-econsultation-to-improve-access-to-quality-gout-care/