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Exploration of an Automated Approach for Receiving Patient Feedback After Outpatient Acute Care Visits

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ABSTRACT

BACKGROUND

To improve and learn from patient outcomes, particularly under new care models such as Accountable Care Organizations and Patient-Centered Medical Homes, requires establishing systems for follow-up and feedback.

OBJECTIVE

To provide post-visit feedback to physicians on patient outcomes following acute care visits.

DESIGN

A three-phase cross-sectional study [live follow-up call three weeks after acute care visits (baseline), one week post-visit live call, and one week post-visit interactive voice response system (IVRS) call] with three patient cohorts was conducted. A family medicine clinic and an HIV clinic participated in all three phases, and a cerebral palsy clinic participated in the first two phases. Patients answered questions about symptom improvement, medication problems, and interactions with the healthcare system.

PATIENTS

A total of 616 patients were included: 142 from Phase 1, 352 from Phase 2 and 122 from Phase 3.

MAIN MEASURES

Primary outcomes included: problem resolution, provider satisfaction with the system, and comparison of IVRS with live calls made by research staff.

KEY RESULTS

During both live follow-up phases, at least 96 % of patients who were reached completed the call compared to only 48 % for the IVRS phase. At baseline, 98 of 113 (88 %) patients reported improvement, as well as 167 of 196 (85 %) in the live one-week follow-up. In the one-week IVRS phase, 25 of 39 (64 %) reported improvement. In all phases, the majority of patients in both the improved and unimproved groups had not contacted their provider or another provider. While 63 % of providers stated they wanted to receive patient feedback, they varied in the extent to which they used the feedback reports.

CONCLUSIONS

Many patients who do not improve as expected do not take action to further address unresolved problems. Systematic follow-up/feedback mechanisms can potentially identify and connect such patients to needed care.

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Acknowledgements

Contributors

No other contributors.

Funders

This research was supported by grant #R18HS017060 from the Agency for Healthcare Research and Quality (AHRQ), and was also supported by grant # P30 AI027767 from NIH-NIAID.

Prior presentations

Portions of this manuscript were presented at the following conferences or lectures listed below.

Berner E et al. (March 2013) Automated Follow-up of Patients in Ambulatory Care: Physician and Patient Views. Presented at the 8th Annual AUPHA Academic Forum, HIMSS-2013, New Orleans, LA.

Berner ES, Burkhardt J, Houser S, et al. Closing the feedback loop to improve diagnostic quality. Presentation at AHRQ HIT Grantees Meeting; June 2010; Bethesda, MD.

Ray MN, Willig J, Cohen M, et al. Follow-up phone calls to improve patient safety in primary care: Issues encountered and lessons learned. Poster presentation at AHRQ HIT Grantees Meeting; June 2010; Bethesda, MD.

Berner ES, Ray MN, Schiff GD, et al. Closing the Feedback Loop to Improve Diagnostic Quality. Poster and abstract at AHRQ Annual HIT Annual Conference; September 7–10, 2008; Bethesda, MD.

Ray MN, Berner ES, Schiff GD, et al. Closing the Feedback Loop to Improve Diagnostic Quality. Poster presentation at Diagnostic Errors in Medicine Conference; June 2008; Phoenix, AZ.

Conflict of Interest

CDNA is copyrighted by the University of Alabama at Birmingham. Eta Berner, Midge Ray, James Willing, Marc Krawitz, and Anantachai Panjamapirom are CDNA inventors. Dr. Berner receives book royalties from Springer-Verlag London Ltd and Health Administration Press. Dr. Panjamapirom is employed by the Advisory Board Company. Dr. Willig has consulted with Qwest Diagnostics and received grants from Definicare. Mr. Krawitz is employed with CareFusion, is a co-owner of Physician Innovations, LLC, and is employed part time by the University of Phoenix.

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Authors and Affiliations

  1. University of Alabama at Birmingham [UAB], Birmingham, AL, USA

    Eta S. Berner EdD, Midge N. Ray RN, MSN, James H. Willig MD, Christa R. Nevin MSPH & Shannon Houser PhD

  2. The Advisory Board Company, Washington, DC, USA

    Anantachai Panjamapirom PhD

  3. Maisiak Consulting, Scottsdale, AZ, USA

    Richard S. Maisiak PhD

  4. University of Massachusetts Medical School, Worcester, MA, USA

    Thomas M. English PhD

  5. Physician Innovations, LLC, Birmingham, AL, USA

    Marc Krawitz MBA

  6. United Cerebral Palsy of Greater Birmingham, Birmingham, AL, USA

    Mark P. Cohen MD

  7. Brigham and Women’s Hospital, Boston, MA, USA

    Gordon D. Schiff MD

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  1. Eta S. Berner EdD
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  2. Midge N. Ray RN, MSN
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  8. Christa R. Nevin MSPH
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  9. Shannon Houser PhD
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Corresponding author

Correspondence to Eta S. Berner EdD.

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Berner, E.S., Ray, M.N., Panjamapirom, A. et al. Exploration of an Automated Approach for Receiving Patient Feedback After Outpatient Acute Care Visits. J GEN INTERN MED 29, 1105–1112 (2014). https://doi.org/10.1007/s11606-014-2783-3

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  • DOI: https://doi.org/10.1007/s11606-014-2783-3

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