The Integrated Dyspnea Clinic: An Evaluation of Efficiency

Abstract

Introduction: Dyspnea is a common complaint and in 70 to 90% the origin is pulmonary or cardiovascular. However, referral to the “wrong” specialism could result in diagnostic- and treatment delay. Integrated care by a cardiologist and a pulmonologist could improve this. The aim of the present study was to evaluate whether integrated care for patients with dyspnea is more efficient and effective than regular care. Methods: Consecutive patients (n = 235) seen at our dyspnea clinic after June 2014 were included. Two patient groups were compared: 1) patients with an integrated consultation and 2) patients with a non-integrated consultation, who were seen by the cardiologist and the pulmonologist on separate occasions. Results: The median time until first diagnosis, final diagnosis and time needed for diagnostic workup was shorter for patients evaluated by a integrated consultation compared with patients with a non-integrated consultation for dyspnea (16 days vs. 37 days, p < 0.001; 51 days vs. 78 days, p < 0.001; 35 days vs. 67 days, p < 0.001). There were no significant differences in the majority of diagnostic tests used and final medical conclusions. Conclusions: Patients with dyspnea evaluated using integrated care were diagnosed almost one month faster than patients in regular care without affecting the type of medical conclusions made. This study supports the start of a dyspnea clinic as an efficient way to provide integrated care to patients with dyspnea. Take home message: Patients with dyspnea evaluated using integrated care where diagnosed one month faster than patients in regular care.

Keywords

• dyspnea
• cardiorespiratory
• health services research
• integrated care
• outcome evaluation
• quality of care