Utility of Automated Calls for Filling Care Gaps in Medical Practice: A 1-Year Initial Experience: 2017 Presidential Poster Award

Abstract

Introduction: Automated outreach systems have been used in several clinical settings to reduce readmission rates, improve outcomes for chronic illness and reduce health-care utilization. To assess the potential for automated post-encounter calls to close common care gaps and those caused by service disruptions in an outpatient clinical practice, we reviewed the first full-year experience in a single-specialty gastroenterology practice. Methods: Automated post-encounter phone calls were made to all patients seen in the clinic during 2016. After confirming the identity of the patient accepting the call, the system asked four questions to identify care gaps related to instructions received during the visit, prescriptions, additional scheduling needs, and overall patient satisfaction. Data collected through an integrated dashboard was reviewed and analyzed for reach rates, issues opened for further staff action, types of care gaps identified, issue resolution rates, and staff actions taken. The practice schedule was examined to identify events during the year that might have disrupted service in the practice. Results: The system performed outreach in the form of automated telephone calls for 9,593 clinic visits, with a success rate of 82% (7,853 patients reached regarding their visit). Of these, 1,677 calls resulted in an issue opened for a staff response (21.4% of patients reached) in 55 different identified categories. A large number of issues opened were attributable to patient mistakes or improper documentation by staff. Patient satisfaction concerns resulted in 170 issues (2.1% of patients reached). Clinically important care gaps were identified in 462 issues (5.9% of patients reached). The ten most frequent issues comprised 474 (75.0%) of the 632 clinical or satisfaction issues opened. Of these, the most frequent issues were triggered by patient questions about instructions (187), prescription medications (120) and care coordination (105). When these issues were compared against known service disruption events that affected the practice during the year, the patterns detected suggest correlations. Conclusion: The automated outreach system resulted in a high reach rate and identified many clinically important service gaps for corrective actions. With small adjustments in the implementation process this type of hybrid-automated outreach system may improve care and mitigate the negative impact of service disruptions in outpatient clinical practice.Figure: Post-Visit Automated Call Engagement Metrics by Month.Figure: Most Frequent (“Top 10”) Actions Taken by Wichita Falls GI Associates Staff in 2016 by Month.Figure: WFGIA Care Gap Documentation and Key Service Disruptions by Month.