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Research Letter
August 28, 2019

Access to Urologic Care Through Clinical Integration in a Large, Underserved Population

Author Affiliations
  • 1David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
  • 2Los Angeles County Department of Health Services, Los Angeles, California
  • 3Greater Los Angeles Veterans Administration, Los Angeles, California
JAMA Surg. Published online August 28, 2019. doi:10.1001/jamasurg.2019.2525

Access to surgical care differs from access to nonsurgical care. Frameworks that account for the efficiency of an initial diagnosis, an appropriate workup, and a subsequent intervention may more accurately reflect meaningful access from the patient’s perspective than does the interval between specialty referral and specialty clinic visit. In an effort to optimize the use of physician specialists in the setting of limited resources1 and to maximize efficiency, the Los Angeles County Department of Health Services (LAC DHS) has pursued clinical integration by concurrently instituting empanelment, an electronic specialty referral system (eConsult; Safety Net Connect), and jointly defined clinical algorithms (expected practices) for managing common diagnoses. We assessed the association of these 3 aspects of clinical integration with access to urologic care.

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