Pulmonary Specialist-Health Coach Consult Model Pilot

• Acceptability[ Time Frame: At least 3 months after model implementation ]
  Response of staff and clinicians at pilot site to question, "On a scale of 0 to 10, with 10 being the highest, how likely are you to recommend this model to colleagues?"
• Provider acceptance of recommended care[ Time Frame: 3 months after referral ]
  Number of specialist recommendations where provider took action; Denominator: Number of recommendations made by specialist

The Pulmonary Specialist-Health Coach Consultation (PuSHCon) study examines the implemention of health coach-assisted consultations to improve access to specialist care and implementation of specialist recommendations for patients with COPD, asthma, and asthma COPD overlap syndrome (ACOS) for low-income and vulnerable patients seen at public health clinics. A limited number of patients (50) from two clinics will be enrolled in the pilot study; 25 patients from one clinic will receive a pulmonary consultation under usual care and 25 patients from the other clinic will receive the PuSHCon model.

• Behavioral: PushCon Model
  Pulmonary specialist consultation facilitated by a trained health coach, who will gather information from the patient and medical record prior to the consultation and will using health coaching skills to support implementation of recommended care.
• Behavioral: Usual care
  Patients referred for pulmonary consultation will be scheduled for an in-person visit at the central hospital-based office. Recommendations will be provided to the primary care clinician. Implementation of those recommendations will rely on follow up of the primary care clinician.

• Experimental: PuSHCon model
  A health coach will contact patients referred by their primary care clinician for a pulmonary specialty visit. The health coach will gather information from the patient and medical record and review the case with a pulmonary specialist. The specialist will provide recommendations to the primary care clinician based on the case review; the specialist may request an in-person patient visit if needed. The health coach will follow up with the primary care clinician and will support implementation of recommendations that the the primary care clinician accepts,
• Active Comparator: Usual care
  Patients referred by their primary care clinician for a pulmonary specialty visit will be scheduled to see a pulmonary specialist, who will send recommendations to the primary care clinician. Implementation of the recommendations will be the responsibility of the primary care clinician.