California's community primary care clinics are the backbone of the state's health care safety net, annually serving more than 2.8 million primarily low-income, minority, and immigrant patients. Lack of timely access to specialty care for the patients, however, is a significant and growing challenge that can lead to poorer health outcomes and unnecessary costs.

In 2007, the California HealthCare Foundation funded COPE Health Solutions (COPE) to initiate local strategies to improve access to specialty services for safety-net clinic patients. Soon thereafter, the Camino de Salud (Road to Health) Network (CDSN) of providers in Los Angeles joined COPE, with the support of other funders, to develop the Provider Practice Redesign project. The project was directed at changing how CDSN providers interacted with specialists at the Los Angeles County/University of Southern California Medical Center to improve access to specialty care.

CDSN's Provider Practice Redesign had several aspects, implemented primarily for care of its rheumatology and cardiology patients:

• Consensus Care Guidelines, collaboratively developed by the network's primary care providers and the specialists;
• "Specialty Champions," primary care providers given specialized training in a particular field by specialists to whom they refer patients;
• Phone consultations between Specialty Champions and specialists, to determine whether a referral is necessary and to assist with some clinic specialty care; and
• Community Grand Rounds, monthly meetings at which providers and leadership discussed challenges to providing specialty care access.

The redesign resulted in both more appropriate referrals and a significant number of specialty patients being managed at primary care sites. Participating primary care providers reported expanded experience and confidence in diagnosing and managing specialty patients themselves.

An issue brief reports on the nature and process of the CDSN redesign and on the project's impact on specialty care access for the network's patients. The brief also discusses some of the challenges encountered and lessons learned from implementation of the redesign.

Independent Project Evauation

An independent evaluation of the project was conducted by the Center for Community Health Studies at the University of Southern California.

The complete issue brief as well as the independent evaluation report are available under Document Downloads.