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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3095 — Evaluation of Outcomes Following a National VHA Telephone Collaborative

LaVela SL, Center for Management of Complex Chronic Care (CMC3), Hines VA Hospital; Gering J, Chillicothe VA Medical Center; Schectman G, Office of Patient Care Services, VA Central Office; Locatelli S, and Weaver FM, CMC3;

Objectives:
To assess Veteran experiences with telephone access/use for primary care purposes before and after a national telephone collaborative was implemented (improvement strategies in primary care clinics).

Methods:
To capture the “voice of the Veteran” regarding primary care telephone experiences, cross-sectional surveys were conducted with Veteran primary care users at VA facilities at 2 time points: pre- (Fall 2009) and post-collaborative (Fall 2010). Bivariate analyses were used to assess differences in pre/post outcomes (timeliness, quality, patient satisfaction, delays in care).

Results:
730 Veterans from 13 VA facilities participated (pre = 314; post = 416), most were male (90%) with a mean age of 62 years. Average travel time to VA primary care clinic was 47 minutes, and 70% reported receiving all of their care at the VA. A greater proportion of Veterans reported that staff answered their call in a timely manner after the collaborative (88%) than before (80%), p = 0.003. Post-collaborative (vs. pre-), there were measureable improvements in patient perceived quality of telephone care (85% vs. 78% rated quality as excellent or good, p = 0.01) and patient satisfaction (87% vs. 82% very/mostly satisfied, p = 0.04). The proportion of Veterans who reported that telephone access issues resulted in a delay in a primary health care concern being addressed significantly reduced from 41% before the collaborative to 15% after, p <0.0001.

Implications:
The findings showed measureable improvements in timeliness of answering incoming calls of Veteran primary care patients. After the collaborative, greater proportions of Veterans viewed their telephone care as high quality and were highly satisfied with their telephone experience. Fewer Veterans experienced delays in primary care as a result of inadequate telephone responsiveness or access.

Impacts:
A medical facility’s telephone systems have a direct impact on patient satisfaction and quality of care, and inefficiencies may result in delays in care receipt. Successful change strategies can be used to modify and improve telephone design infrastructure and systems (protocols, phone call trees, resource allocation and staffing, and shaping demand) that facilitate more efficient management of incoming calls. The current project demonstrated measureable improvements in outcomes after such strategies were implemented in VA primary care clinics as part of a national quality improvement collaborative.


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