COPD eConsult

Pulmonology - COPD eConsult


COPD eConsult


84-year-old female, full code. COPD, morbid obesity, chronic hypoxic respiratory failure on 2L NC, Heart failure with reduced ejection fraction (HFrEF) w/Mitral regurgitation and tricuspid regurgitation (MR/TR) and Ejection fraction (EF) 42%.
Worsening dyspnea is associated with expiratory wheezes, O2 sat at baseline on 2L NC, and a globular filtration rate (GFR) of 55, which is normotensive. Chest radiography (CXR) showed cardiomegaly and vascular congestion. On Lasix 40 mg and Aldactone 25 mg daily added for worsening dyspnea. Her COPD daily maintenance regimen consists of Prednisone 5 mg, Singulair 10 mg, and Incruse 62.5 mg.

Received IM solumedrol and started on high dose prednisone taper, Xopenex QID, inhaled budesonide BID x 7 days. IV was placed for IV cefepime given left shift on complete blood count (CBC).


How can I optimize her respiratory regimen while awaiting a pulmonary medicine appointment and potentially a sleep study?

Navigating the Boom: Healthcare Specialties and Wait Times

The demand for top-quality specialty care in the healthcare industry is on the rise, yet so are the wait times to access these services.

The current top specialties are:

  1. Radiology
  2. Obstetrics and Gynecology
  3. Psychiatry
  4. Gastroenterology



CIN strategy

eConsults Help Clinically Integrated Networks Deliver Better Care and Demonstrate Value?

Clinically Integrated Network (CIN) Strategy Leverages eConsult Technology to Help Physicians and Health Systems Deliver Better Care at Lower Cost

​Physicians increasingly face pressure to deliver high quality care efficiently while continuing to grow and sustain their practices. But lowering costs while sustaining growth often means giving up autonomy. The percentage of solo physicians in the U.S. fell to 17% in 2014, compared with 41% in 1983. Additionally, hospital ownership of physician practices increased from 24% in 2004 to 49% in 2011.

One way that small physician practices have begun combating this trend is by forming clinically integrated networks (CINs), which are groups of providers that come together to improve quality of patient care, reduce costs, and demonstrate value. A large part of a successful CIN strategy involves the implementation of technologies and procedures that facilitate referral management and improve quality and experience of care.

What is a CIN?

CINs are legal structures that facilitate healthcare provider collaboration by creating alliances between physicians, independent groups, and the healthcare system. These structures enable small physician groups to jointly negotiate contracts which form the foundation for value-based arrangements but can also help stakeholders with in-network fee-for-service (FFS) models. According to URAC data, there were an estimated 500 CINs in the U.S. as of 2015.

McKinsey defines a CIN as “as a network of interdependent and cooperative providers who continuously evaluate and modify their clinical practices in accordance with agreed-upon protocols to control costs and improve quality.”

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