# Applying Relational Coordination to Implement a Pulmonary E-consult Intervention

> **NIH VA IK2** · EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL · 2021 · —

## Abstract

Introduction: This is the second submission of a VA HSR&D CDA proposal for Seppo Rinne, MD PhD. Dr.
Rinne is a practicing VA Pulmonologist, Clinical Informaticist, and a Core Investigator in the HSR&D Center for
Healthcare Organization and Implementation Research (CHOIR). This proposal incorporates extensive
revisions to address prior reviewer comments, which has led to a refined research focus and a rigorous career
development plan. Since the first CDA submission, Dr. Rinne transferred to a new VA research environment
that is closely aligned with his career goals, updated his mentoring and advising team to support these new
goals, and established strong working relationships with key operational partners. The current proposal builds
on Dr. Rinne’s previous training experiences and preliminary research to improve multidisciplinary coordination
of pulmonary care by developing and implementing a theoretically-based informatics intervention.
Background: Access to specialty care is often insufficient to meet demand. To improve timeliness and
efficiency of specialty care, VA implemented electronic consultations (e-consults), which allow asynchronous
provider-provider coordination through the electronic health record. However, limited research has considered
potential unintended consequences of e-consults on patients’ and providers’ relationships and their quality of
communication. Relational Coordination (RC) Theory provides insight that can address these gaps in
knowledge and inform the design and implementation of e-consult interventions.
Objective: To combine RC Theory with an established implementation model to guide the following Aims:
 Aim 1: Explore patient, PCP, and pulmonologist perspectives of e-consults and relationships.
 Aim 2: Develop consensus on essential components of pulmonary e-consult communication.
 Aim 3: Design and implement a pulmonary E-consult-First intervention.
Methods: Aim 1 will use semi-structured interviews to explore perspectives on how e-consults impact
interpersonal relationships and how patients and providers develop high quality relationships in the context of
frequent e-consult use. Aim 2 will use a multi-step process with Delphi panels and Veteran focus groups to
develop consensus on essential components of pulmonary e-consult communication. Aim 3 will: (A) apply a
novel implementation strategy using social network analysis to identify influential individuals who can act as
change agents; (B) work with these individuals and other local stakeholders to adapt information from Aims 1
and 2 to develop an e-consult intervention; and (C) evaluate the effect of the intervention and implementation
strategy by conducting interviews to assess implementation outcomes, interrupted time-series analysis to
examine wait times, and patient and provider surveys on satisfaction and the quality of coordination.
Expected results: The proposed research will identify evidence-based practices to build and maintain patient
and provider ...

## Key facts

- **NIH application ID:** 10295027
- **Project number:** 5IK2HX002248-03
- **Recipient organization:** EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL
- **Principal Investigator:** Seppo T Rinne
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-01-01 → 2023-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10295027

## Citation

> US National Institutes of Health, RePORTER application 10295027, Applying Relational Coordination to Implement a Pulmonary E-consult Intervention (5IK2HX002248-03). Retrieved via AI Analytics 2026-05-29 from https://api.ai-analytics.org/grant/nih/10295027. Licensed CC0.

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