Evaluation of a patient communication pilot program and patient appointment reminder calls

Transcription

1 Evaluation of a patient communication pilot program and patient appointment reminder calls May 8, 2013 Presented to:

2 Presenters Leah Picardi Gallivan, M.S.W., M.S., Chief Operating Officer, Edward M. Kennedy CHC Deborah Gurewich, Ph.D., Associate Director, Research & Evaluation, UMass Medical School Susan West Levine, M.P.H., Managing Director, UHealthSolutions, Inc. an affiliate of UMass Medical School

3 Presentation Outline Background: Patient Communications Pilot Program Evaluation Aims and Methods Evaluation Findings Next Steps

4 Patient Communications Pilot Program

5 The Health Center Challenge High call volumes, abandonment rate Balancing in-person and phone support Cost of no shows Limited resources available for outbound calls Quality monitoring, reporting, and analytics Maintaining protocols and call flows Providing ongoing, dedicated training Standardizing services across multiple sites

6 The Solution Establish a pilot program to centralize communication functions across all sites and begin the identification and implementation of best practices to improve patient access and satisfaction.

7 The Partners Edward M. Kennedy Community Health Center (EMK CHC) UHealthSolutions, Inc., a nonprofit affiliate of UMass Medical School (UHS) Mass League of Community Health Centers and the Commonwealth Purchasing Group (CPG)

8 Pilot Goals Improve access to primary and preventive care Enhance and improve the quality of the patient experience Decrease no-show rates and optimize schedule efficiency Increase completion rate of outbound calls Decrease abandonment rate of inbound calls

9 Core Services Provided Outbound live appointment reminders After-hours answering service Inbound call management Answering call during normal operating hours Appointment scheduling Clinic cancellation notifications Appointment rescheduling at time of reminder call

10 Pilot Approach: UHS as an extension of health center services Outsource and centralize communication functions Leverage linguistically diverse and culturally competent workforce Use patient s preferred communication mode and language Dedicate patient communication specialists to help patients navigate care Leverage call center/telephony infrastructure

11 Implementation Executive Sponsorship Joint Working Group Guiding principles Shared culture/mission alignment Communication plan Provider meetings Site visits/pictures by UHS staff Best practices Phased implementation plan Committing time and resources Ongoing quality improvement

12 Joint Guiding Principles Ensure open, informal, timely, and responsive communication Overcome issues and challenges together Operate as one, seamless operation Serve as champions of the pilot program Embrace change Celebrate successes Utilize data to drive operational decisions Commit to continuous improvement

13 Phased Implementation Live Appointment Reminder Calls April 2012 EMK CHC Framingham Inbound Call Management May 2012 After-Hours Answering Service May 2012 All Inbound Calls and Appointment Scheduling October 2012

14 Operational Benefits Dedicated staff making all reminder calls Detailed call reporting and analytics to pinpoint trouble spots Workforce management to assign staff according to call arrival patterns Tailored patient communications quality management program and score card

15 Early Operational Metrics Average of 937 incoming calls/day Average of 619 appointment reminder calls/day Achieved 80/20 service level Decreased abandonment rate from 11% to 5%

16 Areas of Interest and Next Steps Mini Pilots for outreach and follow-up Well-child visits Women s preventive care screening Referral follow-ups Text and appointment reminders Filling cancelled slots Leveraging grant funding Additional areas of study Support targeted initiatives Workforce development

17 Lessons Learned Challenges Organic growth led to incomplete documentation Managing expectations Developing and improving workflows once calls are transferred to the health center Overcoming potential technical limitations Measuring cost and investing appropriately Opportunities Developing call flows, best practices, and written procedures Learning together and making real-time adjustments Dedicating staff to other essential patient care functions Increasing revenues by optimizing schedule Building a communication infrastructure for success in new payment models

18 Evaluation Aims and Methods

19 Evaluation Aims Assess appointment reminder system Call reminder completion rates Factors associated with patient no-show rate Pinpoint conditions that support and impede implementation of program elements

20 Study Approach Quantitative Methods Study aims related to call reminder system performance Qualitative Methods Study aims related to program implementation Funded by UMMS Commonwealth Medicine Internal Grants Initiative

21 Quantitative Analysis Data Call disposition data (UHS) Patient demographic and appointment status data (EMK CHC) Sample Six-month call disposition data (Jul. Dec. 2012) Two-week call disposition data merged with patient demographic data (Feb. Mar. 2013)

22 Quantitative Analysis (cont.) Descriptive Call disposition completion and outcome rates Comparison of show and no-show patients Multivariate Analysis Dependent variable: Appointment (show v. no-show) Independent variables: Call disposition Patient age, gender, race/ethnicity, and language Appointment date, service type, and location

23 Qualitative Data Key Informant Interviews (N=10) Heads of administration, clinical, front desk Data Collection and Analysis One-hour interviews Semi-structured interview guides Content coding and pattern matching

24 Evaluation Findings

25 Call Disposition (6 months) (n=77,002 appointments) Missing data 1% Disposition not specified Patient cancelled/ rescheduled Did not get through* 1% 3% 12% Left voice or live message Patient confirmed 39% 44% 0% 10% 20% 30% 40% 50% *Busy signal, hung up, wrong number, no answer, number changed, phone disconnected

26 Show vs. No-Show and Call Disposition 60% 50% 54% N=4,506 Appointments (2 weeks) 40% 30% 37% 31% 36% Kept Appts No Show Appts 20% 19% 10% 0% Patient confirmed 6% 6% Left message (person) Left message (voic ) 8% Could not get through 1% 2% Other p<0.001

27 Show vs. No-Show (cont.) Total Population = 4,506 Appointment Status, n (%) Age Show No-Show Chi-Square (α=0.05) <9 324 (9.2) 111 (11.3) (7.2) 104 (10.6) (39.9) 436 (44.6) (35.1) 264 (27.0) (8.6) 63 (6.4) < Gender Show No-Show Chi-Square (α=0.05) Female 2186 (62.0) 589 (60.2) Male 1342 (38.0) 389 (39.8) Race Show No-Show Chi-Square (α=0.05) White 2392 (67.8) 650 (66.5) Black 558 (15.8) 174 (17.8) Multi-Racial 398 (11.3) 109 (11.1) Asian 162 (4.6) 35 (3.6) Other 18 (0.5) 10 (1.0)

28 Show vs. No-Show (cont.) Total Population = 4,506 Appointment Status, n (%) Ethnicity Show No-Show Chi-Square (α=0.05) Hispanic 1778 (50.4) 516 (52.8) Non-Hispanic 1750 (49.6) 462 (47.2) Language Show No-Show Chi-Square (α=0.05) English 1516 (43.0) 493 (50.4) Spanish 1112 (31.5) 301 (30.8) Portuguese 594 (16.8) 116 (11.9) Other 306 (8.7) 68 (6.9) < Day of the Week Show No-Show Chi-Square (α=0.05) Monday 951 (27.0) 282 (28.8) Tuesday 777 (22.0) 196 (20.0) Wednesday 703 (19.9) 163 (16.7) Thursday 704 (19.9) 206 (21.1) Friday 300 (8.5) 91 (9.3) Saturday 93 (2.6) 40 (4.1)

29 Show vs. No-Show (cont.) Total Population = 4,506 Appointment Status, n (%) Location Show No-Show Chi-Square (α=0.05) Clinton 160 (4.5) 37 (3.8) Framingham 548 (15.5) 76 (7.8) Worcester 2820 (79.9) 865 (88.4) < Type of Service Show No-Show Chi-Square (α=0.05) Behavioral Health 540 (15.3) 127 (13.0) Dental 977 (27.7) 291 (29.7) Medical 1618 (45.9) 378 (38.6) Other 393 (11.1) 182 (18.6) <0.0001

30 Multivariate Analysis Results: Determinants of Appointment Show Patient more likely to show if: Older (44 years and older) compared to younger (20 44 years) Non-English speaking vs. English speaking Received reminder call that confirmed appointment or left message vs. call reminder that could not get through (busy, disconnected, etc.)

31 Multivariate Analysis Results: Determinants of Appointment Show (cont.) Patient less likely to show if: Appointment for specialty care (optical, specialty, other) compared to routine medical care Appointment scheduled on Monday or Thursday compared to Wednesday

32 Implementation Facilitators Cultural alignment Centralization already in the air Strong quality improvement Leadership and key stakeholder support Proximity between EMK and UHS Sense of joint mission Hire existing CHC staff Technical capacity (electronic health record and practice management system)

33 Implementation Challenges Call protocol development and maintenance After-hour calls especially (more customization) Remote call center limitations Limited ability to route calls to phone extensions Can t physically track people down On-going call center staff training Adherence to call protocols/correct call routing

34 Implications Implementation not easy but worth it Frees up staff time for patients (not phones) Improved tracking to support QI Appointment show rate varies across patient and health center-level characteristics Opportunity to customize call reminder system

35 Study Limitations Unknown factors associated with patients that can t be reached by phone Small sample (single site, etc.) Not all stakeholders represented No pre-implementation data

36 Next Steps

37 Next Steps Target interventions based on study findings Adjust Monday appointment calls from Thursdays to Fridays or Saturdays Focus on the 12% did not get through Implement alternative methods for appointment reminders Identify areas for further study & secure grant funding

38 Thank you. Questions?