TY - JOUR
T1 - Call Center Remote Triage by Nurse Practitioners Was Associated With Fewer Subsequent Face-to-Face Healthcare Visits
AU - Kaboli, Peter J.
AU - Augustine, Matthew R.
AU - Rose, Danielle E.
AU - Chawla, Neetu
AU - Bouchard, Maria
AU - Hebert, Paul
N1 - Funding Information:
This material is based upon work supported (or supported in part) by the Department of Veterans Affairs, Veterans Health Administration, Office of Nursing Services, VA Office of Rural Health, and the Office of Research and Development, Health Services Research and Development (HSR&D) Service through the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center (CIN 13-412). It was also undertaken as part of the Department of Veterans Affairs’ Primary Care Analytics Team, supporting and evaluating VA’s transition to a patient-centered medical home. Funding for the Primary Care Analytics Team is provided by the VA Office of Primary Care. Thank you to Emily Ashmore for the preparation of figures and Kelby Rewerts for editing assistance.
Publisher Copyright:
© 2021, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.
PY - 2021/8
Y1 - 2021/8
N2 - Background: In 2015, the Veterans Health Administration (VHA) incorporated nurse practitioners (NPs) into remote triage call centers to supplement registered nurse (RN)–handled calls. Objective: To assess 7-day healthcare use following telephone triage by NPs compared to RNs. We hypothesized that NP clinical decision ability may reduce follow-up healthcare. Design: Retrospective observational comparative effectiveness study of clinical and administrative databases. NP routed calls were matched to RN calls based on chief complaint with propensity score matching and multivariate count data models, adjusting for differences in call severity and patient comorbidity. Participants: Callers to a VHA regional call center, April 2015 to March 2019. Main Measures: Primary care, specialty care, and emergency department (ED) visits plus hospitalizations within 7 days. Key Results: NP-handled calls (N = 1554) were matched to RN calls (N = 48,024) for the same chief complaint. NP-handled calls, compared to RNs, had lower comorbidities, fewer hospitalizations, and less urgent complaints. Seven-day healthcare use was lower for NP compared to RN calls for specialty care (0.15 vs. 0.20 visits per person [VPP]; p < 0.001), ED (0.11 vs. 0.27 VPP; p < 0.001), and hospitalizations (0.01 vs. 0.04 VPP; p < 0.001), but not primary care (0.43 vs. 0.42 VPP; p = 0.80). In adjusted analyses, estimated avoided in-person visits per 100 calls routed to NPs were 0.7 primary care visits (95% confidence interval [CI] 0.4, 1.0), 2.6 specialty care visits (95% CI 0.0, 5.1), 5.9 ED visits (95% CI 2.7, 9.1), and 1.4 hospital stays (95% CI 0.1, 2.6). Propensity score–matched models comparing NP (N = 1533) to RN (N = 2646) calls had adjusted odds ratios for 7-day healthcare use of 0.75 (primary care), 0.75 (specialty care), and 0.73 (ED) (all p < 0.003). Conclusion: Incorporating NPs into a call center was associated with lower in-person healthcare use in the subsequent 7 days compared to routine RN-triaged calls.
AB - Background: In 2015, the Veterans Health Administration (VHA) incorporated nurse practitioners (NPs) into remote triage call centers to supplement registered nurse (RN)–handled calls. Objective: To assess 7-day healthcare use following telephone triage by NPs compared to RNs. We hypothesized that NP clinical decision ability may reduce follow-up healthcare. Design: Retrospective observational comparative effectiveness study of clinical and administrative databases. NP routed calls were matched to RN calls based on chief complaint with propensity score matching and multivariate count data models, adjusting for differences in call severity and patient comorbidity. Participants: Callers to a VHA regional call center, April 2015 to March 2019. Main Measures: Primary care, specialty care, and emergency department (ED) visits plus hospitalizations within 7 days. Key Results: NP-handled calls (N = 1554) were matched to RN calls (N = 48,024) for the same chief complaint. NP-handled calls, compared to RNs, had lower comorbidities, fewer hospitalizations, and less urgent complaints. Seven-day healthcare use was lower for NP compared to RN calls for specialty care (0.15 vs. 0.20 visits per person [VPP]; p < 0.001), ED (0.11 vs. 0.27 VPP; p < 0.001), and hospitalizations (0.01 vs. 0.04 VPP; p < 0.001), but not primary care (0.43 vs. 0.42 VPP; p = 0.80). In adjusted analyses, estimated avoided in-person visits per 100 calls routed to NPs were 0.7 primary care visits (95% confidence interval [CI] 0.4, 1.0), 2.6 specialty care visits (95% CI 0.0, 5.1), 5.9 ED visits (95% CI 2.7, 9.1), and 1.4 hospital stays (95% CI 0.1, 2.6). Propensity score–matched models comparing NP (N = 1533) to RN (N = 2646) calls had adjusted odds ratios for 7-day healthcare use of 0.75 (primary care), 0.75 (specialty care), and 0.73 (ED) (all p < 0.003). Conclusion: Incorporating NPs into a call center was associated with lower in-person healthcare use in the subsequent 7 days compared to routine RN-triaged calls.
KW - after-hours care
KW - call center
KW - telephone medicine
KW - telephone triage
UR - http://www.scopus.com/inward/record.url?scp=85099765445&partnerID=8YFLogxK
U2 - 10.1007/s11606-020-06536-0
DO - 10.1007/s11606-020-06536-0
M3 - Article
C2 - 33501532
AN - SCOPUS:85099765445
SN - 0884-8734
VL - 36
SP - 2315
EP - 2322
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
IS - 8
ER -