Standard nurse phone triage versus tele–emergency care pilot on <scp>Veteran</scp> use of in‐person acute care: An instrumental variable analysis

Li, Kathleen; Kim, Paul S.; Thariath, Joshua; Wong, Edwin S.; Barkham, Jonathan; Kocher, Keith E.

doi:10.1111/acem.14681

Cited by 3 publications

(1 citation statement)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Li et al have published an evaluation of a similar program for veterans in the US which compares the clinical outcomes of telephone triage utilizing emergency physicians in addition to nurses versus nurses alone. However, the focus of this program was to better direct patients to in-network emergency departments rather than identify the most appropriate modality of care, precluding direct comparison to HEiDi [16]. In a previously published description and process evaluation of the HEiDi service, VPs advised 72.1% of urgently triaged callers away from visiting EDs or urgent care clinics within 24 h, while advising 15.0% of callers whose concerns were deemed less urgent by the nurse to attend an ED immediately [6].…”

Section: Physician Assistance In Telephone Triage and Advicementioning

confidence: 99%

Concordance between 8-1-1 HealthLink BC Emergency iDoctor-in-assistance (HEiDi) virtual physician advice and subsequent health service utilization for callers to a nurse-managed provincial health information telephone service

Duncan,

Stewart,

Scheuermeyer

et al. 2023

BMC Health Serv Res

View full text Add to dashboard Cite

Background British Columbia 8–1-1 callers who are advised by a nurse to seek urgent medical care can be referred to virtual physicians (VPs) for supplemental assessment and advice. Prior research indicates callers’ subsequent health service use may diverge from VP advice. We sought to 1) estimate concordance between VP advice and subsequent health service use, and 2) identify factors associated with concordance to understand potential drivers of discordant cases. Methods We linked relevant provincial administrative databases to obtain inpatient, outpatient, and emergency service use by callers. We developed operational definitions of concordance collaboratively with researcher, patient, VP, and management perspectives. We used Kaplan–Meier curves to describe health service use post-VP consultation and Cox regression to estimate the association of caller factors (rurality, demography, attachment to primary care) and call factors (reason, triage level, time of day) with concordance as hazard ratios. Results We analyzed 17,188 calls from November 16, 2020 to April 30, 2021. Callers advised to attend an emergency department (ED) immediately were the most concordant (73%) while concordance was lowest for those advised to seek Family Physician (FP) care either immediately (41%) or within 7 days (47%). Callers unattached to FPs were less likely to schedule an FP visit (hazard ratio = 0.76 [95%CI: 0.68–0.85]). Rural callers were less likely to attend an ED within 48 h when advised to go immediately (0.53 [95%CI:0.46–0.61]) compared to urban callers. Rural callers advised to see an FP, either immediately (1.28 [95%CI:1.01–1.62]) or within 7 days (1.23 [95%CI: 1.11–1.37]), were more likely to do so than urban callers. Interpretation Concordance between VP advice and subsequent caller health service use varies substantially by category of advice and caller rurality. Concordance with advice to “Go to ED” is high overall but to access primary care is below 50%, suggesting potential issues with timely access to FP care. Future research from a patient/caller centered perspective may reveal additional barriers and facilitators to concordance.

show abstract

Section: Physician Assistance In Telephone Triage and Advicementioning

confidence: 99%

Concordance between 8-1-1 HealthLink BC Emergency iDoctor-in-assistance (HEiDi) virtual physician advice and subsequent health service utilization for callers to a nurse-managed provincial health information telephone service

Duncan,

Stewart,

Scheuermeyer

et al. 2023

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

Medical advice lines offering on-demand access to providers reduced emergency department visits

Tran,

Rose,

Suzuki

et al. 2023

Health Affairs Scholar

View full text Add to dashboard Cite

Instant access to clinicians through virtual care is designed to allow patients to receive care they need while avoiding high-cost visits in acute-care settings. This study investigates the effect of offering patients the option to instantly connect with emergency care providers instead of being referred to the emergency department (ED) following calls to a medical advice line. We used a staggered rollout design to assess the effects of implementing this program on key outcomes among Veterans Affairs enrollees. Analyzing over 1 million calls from 2019 to 2022, we found that access to a provider reduced the proportion of patients who subsequently visited the ED compared with those with access to the standard medical advice line (38% vs 36%). There was no significant difference observed in subsequent inpatient admissions or 30-day mortality. We found that a majority of callers (65%) achieved issue resolution or were directed to lower acuity settings for further evaluation. Although substantial direct cost savings were not evident, our findings demonstrate that on-demand access to a virtual provider can effectively decrease ED visits.

show abstract

Telephone versus video consultations: A systematic review of comparative effectiveness studies and guidance for choosing the most appropriate modality

Caffery,

Catapan,

Taylor

et al. 2024

J Telemed Telecare

View full text Add to dashboard Cite

Objective This systematic review compared clinical, service and cost effectiveness of telephone consultations (TC) to video consultations (VC). Methods We searched Embase, CINAHL and MEDLINE for empirical studies that compared TC to VC using clinical, service or economic outcome measures. Clinician or patient preference and satisfaction studies were excluded. Findings were synthesised descriptively. Results A total of 79 articles were included. The most effective modality was found to be VC in 40 studies (50%) and TC in 3 (4%). VC and TC were found to be equivalent in 28 of the included articles (35%). VC were superior or equivalent to TC for all clinical outcomes. When compared to TC, VC were likely to have better patient engagement and retention, to improve transfer decisions, and reduce downstream sub-acute care utilisation. The impact of telehealth modality on consultation time, completion rates, failure-to-attend rates and acute care utilisation was mixed. VC were consistently found to be more cost effective despite having a higher incremental cost than TC. Conclusions Our systematic review demonstrates equal or better, but not inferior clinical and cost outcomes for consultations delivered by VC when compared to TC. VC appear to be more clinically effective when visual information is required, when verbal communication with the patient is impaired and when patient engagement and retention is linked to clinical outcomes. We have provided conditions where VC should be used in preference to TC. These can be used by clinicians to guide the choice of telehealth modality. Cost effectiveness is also important to consider when choosing modality.

show abstract

Standard nurse phone triage versus tele–emergency care pilot on Veteran use of in‐person acute care: An instrumental variable analysis

Cited by 3 publications

References 22 publications

Concordance between 8-1-1 HealthLink BC Emergency iDoctor-in-assistance (HEiDi) virtual physician advice and subsequent health service utilization for callers to a nurse-managed provincial health information telephone service

Concordance between 8-1-1 HealthLink BC Emergency iDoctor-in-assistance (HEiDi) virtual physician advice and subsequent health service utilization for callers to a nurse-managed provincial health information telephone service

Medical advice lines offering on-demand access to providers reduced emergency department visits

Telephone versus video consultations: A systematic review of comparative effectiveness studies and guidance for choosing the most appropriate modality

Contact Info

Product

Resources

About