Journal article
Call Center Remote Triage by Nurse Practitioners Was Associated With Fewer Subsequent Face-to-Face Healthcare Visits
Journal of general internal medicine : JGIM, Vol.36(8), pp.2315-2322
01/26/2021
DOI: 10.1007/s11606-020-06536-0
PMCID: PMC7837076
PMID: 33501532
Abstract
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.
Details
- Title: Subtitle
- Call Center Remote Triage by Nurse Practitioners Was Associated With Fewer Subsequent Face-to-Face Healthcare Visits
- Creators
- Peter J. Kaboli - Iowa City VA Health Care SystemMatthew R. Augustine - James J. Peters VA Medical CenterDanielle E. Rose - VA Greater Los Angeles Healthcare SystemNeetu Chawla - VA Greater Los Angeles Healthcare SystemMaria Bouchard - VA Desert Pacific Healthcare NetworkPaul Hebert - VA Puget Sound Health Care System
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.36(8), pp.2315-2322
- Publisher
- Springer International Publishing
- DOI
- 10.1007/s11606-020-06536-0
- PMID
- 33501532
- PMCID
- PMC7837076
- ISSN
- 0884-8734
- eISSN
- 1525-1497
- Grant note
- ;
- Language
- English
- Date published
- 01/26/2021
- Academic Unit
- Epidemiology; Internal Medicine
- Record Identifier
- 9984359784202771
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