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The Power of a Telephone
July 1, 2008
Sometimes picking up the phone can make a world of difference. In two pilot projects, congestive heart failure patients who make daily phone calls to an automated service are entering the hospital far less often than would otherwise be expected.
The patients place a call each weekday, answering a series of questions using the keys on their touch-tone phones. Nurses monitor their responses via a Web site, calling the patients when their answers indicate that they may need some guidance or treatment to avoid getting sicker.
The Medicaid program in Iowa is in the second year of its project using technology from Pharos Innovations LLC, Northfield, Ill. The project has been so successful that the program is continuing the use of the technology using its own funding now that an initial grant has been spent.
Meanwhile, Billings (Mont.) Clinic is in its third year of a test project that could ultimately result in extra reimbursement from Medicare for keeping patients out of the hospital.
“By catching new symptoms on day one, a nurse is able to intervene in a telephone triage manner,” says F. Douglas Carr, M.D., medical director, education and systems initiatives, at Billings Clinic. “If there’s a delay of several days, the patient will wind up in the emergency room.”
Measurable Results
In the Medicare pilot at Billings Clinic, the hospitalization rate for participating patients was at least 40% lower than the typical rate for heart failure patients, Carr says. As a result, he estimates the savings to Medicare at more than $1.7 million per year. A similar project is ongoing at Park Nicollett Health Services in St. Louis Park, Minn.
During the one-year period ending October 2007, the number of inpatient admissions for 187 participants in the Iowa Medicaid test program was 43% lower than for a control group of similar patients not participating, organizers say. Total charges for all health care services utilization during the period were $13 million less for participants than for the control group.
These projects are simply automating the longstanding, effective practice of frequent interaction with chronically ill patients, says Carol Stone, R.N., a regional manager at Beacon Partners, a Weymouth, Mass.-based consulting firm. “With congestive heart failure patients, changes can occur quickly, so if you can get daily reports you can see trends,” she says.
For example, if a heart patient gains weight suddenly, a clinician can adjust their medication to control water retention, avoiding potentially serious complications, Stone notes. “It’s the trending of the data that’s most important.”
It’s unrealistic to expect seriously ill heart patients to monitor their symptoms on their own and then take the initiative of calling in when they see a potential problem, she adds. “It’s much better to have the patient answer six questions each day and let someone else make the analysis.”
Cardiac patients participating in both programs make a daily phone call to answer a series of simple questions:
* Have you noticed more swelling in the last day?
* Did you wake up short of breath last night?
* Did you sleep in a chair or prop up with pillows more than usual last night?
* Have you had any lightheadedness or dizziness in the last day?
* Please enter this morning’s weight.
* Have you felt more short of breath in the last day?
Nurses review the answers on the Pharos Web site to determine whether to follow up with the patient. Then they document their actions on the Web site.
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