The adult congenital heart disease collaborative care model: Improving access with a care delivery innovation

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Background: There is a critical nationwide access gap for the care of adults with congenital heart disease (ACHD). In Hawaii, where there are only 2 ACHD cardiologists serving the broader state-wide healthcare system, at most 10% of ACHD patients receive specialty care. Our goal was to 1) design and implement a novel program structured to provide high-quality ACHD care to a large population of patients by a limited number of ACHD specialists; and 2) evaluate the preliminary impact of this program on ACHD specialty care clinic volume. Methods: We built a novel care delivery model wherein the University of Washington AIMS Psychiatric Collaborative Care Model (CoCM) is adapted to expand the reach of ACHD specialists via team-based care coordination and integration of adult cardiologists and primary care providers. To evaluate the impact on access, we compared clinic volume during the pilot implementation phase in April - May 2026, to the volume of patients seen during 2023. Results: Within 5 months of implementation, the ACHD CoCM average weekly clinic volume was 19.6 patients per 0.2 FTE ACHD cardiologist, compared to the traditional care model baseline of 10.5 ACHD patients. Conclusions: We launched a novel ACHD CoCM to improve access to high-quality ACHD care using carefully orchestrated care coordination and integration of primary treating providers, with preliminary data suggesting a ∼2-fold increase in specialty care clinic volume. We estimate with refinements this could ultimately expand each ACHD cardiologist's panel capacity by 3.3 times compared to a traditional care model.

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