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Computerized calls improve scheduling
Imagine you called all your diabetic patients once a week to check on their blood glucose control, ask about related symptoms, and give them patient education. Or you called patients to remind them about the need for immunizations, mammograms, or Pap smears. Sound expensive, time-consuming, and impossible? Not if the caller is a computer.
Interactive voice response systems can actually save money and improve patient care without adding to a medical group's staff burden. Automated reminders can reduce appointment no-shows by 24% to 46%, according to one study.1 They can administer simple patient satisfaction surveys.
More significantly, they can become a tool for disease management. In one study of diabetics, 61% reported symptoms of poor glucose control; a nurse educator followed up on the automated calls, sometimes addressing serious health problems.2 Preliminary results of a two-year, randomized controlled trial of 600 diabetes patients show that automated calls improved patient compliance with standard diabetes care guidelines, such as getting foot exams and annual ophthalmologic exams.
"Many patients say it is a very useful reminder to them to do the things they need to do to stay well," says John D. Piette, PhD, senior research associate center for health care evaluation at the Veterans Affairs Palo Alto (CA) Health Care System. "It does provide that link with patients who have difficulty coming in to clinic. Nurses have identified patients who could have developed significant acute illnesses and have prevented those."
How do patients feel about answering the phone and talking to a computer?
Most don't mind at all, says Piette, who is also consulting assistant professor in the Department of Health, Research, and Policy at Stanford University in Palo Alto, CA. In fact, used with a disease management program, the calls can provide a more personal connection with their caregivers, says Piette, who tested the TeleMinder system developed by Decision Systems of Los Altos, CA. (For contact information on vendors, see box, above right.)
"We found, by and large, [patients] view this as a resource and an indication that they're being cared for; they're being watched," he says. "They find it comforting, in a way. It does elicit a call from an actual nurse.
"This could not stand alone," he adds. "That rapport with the nurse [who follows up on problem calls] spills over into how they feel about getting the automated calls. They see it as an extension of their care."
What about calls to remind patients about appointments or offer satisfaction surveys? Again, patients don't seem to mind, says Marti Lythgoe, marketing manager for SmartTalk in Boulder, CO. A computerized telephone survey gives patients a greater sense of confidentiality than when they fill out a form at the checkout desk in the medical office, she explains. Miller Orthopaedic Clinic in Charlotte, NC, has reduced missed appointments by implementing SmartTalk and periodically uses it to administer a short patient satisfaction survey.
Only six or eight patients out of thousands seen by the clinic's physicians have asked not to be called by the system. Massa can easily block calls to those people.
To monitor patient satisfaction, Massa still hires a consultant to conduct a statistically valid survey based on sampling. But the SmartTalk system allows the practice to take a "pulse" of customer service and patient satisfaction issues, he says.
For example, one question asks patients how long they waited to see a provider. They can press the numbers 1 to 4 to indicate if the wait was less than 10 minutes, 10 to 20 minutes, 20 to 30 minutes, or more than 30 minutes. "We're looking for patterns," says Massa, who adds that he gives the information to providers to make scheduling adjustments.
The system also asks patients whether the doctor fully explained tests and procedures and how they would describe their overall visit - pressing 1 to 5 for a scale of excellent to poor.
"It takes less than a minute for the patient to take this survey," he says.
What if the computer calls and the patient isn't the one who answers? These interactive voice response systems can be programmed to wait for someone to come to the phone, leave a message on an answering machine, or call back. Patients also may influence the timing of calls. For example, Piette asked patients to provide their preferences for time-of-day that they wished to receive the calls. Even so, older patients proved easier to reach than younger ones, he says.
Physicians usually advise patients about the automated systems. The practice may provide brochure, or the staff may wear buttons to publicize the program or a hotline number.
"Patients have an option of calling into the survey line to take the [satisfaction] survey at their convenience," says Lythgoe. "Patient education is really important to improve the response to the call."
References
1. Leirer VO, Tanke ED, and Morrow DG. Commercial cognitive/memory systems: A case study. Applied Cognitive Psychology 1993; 7:675-689.
2. Piette JD and Mah CA. The feasibility of automated voice messaging as an adjunct to diabetes outpatient care. Diabetes Care 1997; 20:15-21.
Improving Health Care Quality - June 22-24, Portland, OR. Sponsored by the Institute for Healthcare Improvement, 135 Francis St., Boston, MA 02215. Telephone: (617) 754-4800. Fax: (617) 754-4848.
Methods and Tools for Breakthrough Performance - June 29-July 1, Portland, OR. Sponsored by the Institute for Healthcare Improve-ment, 135 Francis St., Boston, MA 02215. Telephone: (617) 754-4800. Fax: (617) 754-4848.
High Performance: Demonstrating Quality of Care and Service - July 13-14, Portland, OR. Sponsored by the National Committee for Quality Assurance, Education Department, 2000 L Street, N.W., Suite 500, Washington, DC 20036. Telephone: (202) 955-5697. Fax: (202) 955-3531. E-mail: [email protected]. World Wide Web: http://www.ncqa.org.
The following are sources quoted in this month's issue.
Colorado Neurological Institute, Englewood, CO. Kristen Mahan-Moutaw, Manager of Clinical Outcomes. Telephone: (303) 788-4033. E-mail: [email protected].
Lawson & Associates, Sacramento, CA. Alfredo Czerwinski, Principal. Telephone: (916) 455-2083. E-mail: [email protected].
Milestone Advisory Group, Murfreesboro, TN. Gale Stoner, President. Telephone: (800) 849-9674.
Nalle Clinic, Charlotte, NC. Darlene Trandel-Korenchuk, Grant and Community Outreach Director. Telephone: (704) 342-8265. E-mail: [email protected].
Sullivan/Luallin, San Diego, CA. Meryl Luallin, Principal. Telephone: (619) 283-8988.
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