Currently Viewing:
The American Journal of Managed Care March 2011
Fracture Risk Tool Validation in an Integrated Healthcare Delivery System
Joan C. Lo, MD; Alice R. Pressman, MS, PhD; Malini Chandra, MS; and Bruce Ettinger, MD
Currently Reading
Improving Endoscopy Completion: Effectiveness of an Interactive Voice Response System
Joan M. Griffin, PhD; Erin M. Hulbert, MS; Sally W. Vernon, PhD; David Nelson, PhD; Emily M. Hagel, MS; Sean Nugent, BA; Alisha Baines Simon, MS; Ann Bangerter, BS; and Michelle van Ryn, PhD
Healthcare Spending and Preventive Care in High-Deductible and Consumer-Directed Health Plans
Melinda Beeuwkes Buntin, PhD; Amelia M. Haviland, PhD; Roland McDevitt, PhD; and Neeraj Sood, PhD
Regulating the Medical Loss Ratio: Implications for the Individual Market
Jean M. Abraham, PhD; and Pinar Karaca-Mandic, PhD
On Telephone-Based Disease Management: Wrong Diagnosis, Right Prescription
Christobel Selecky; Reply by Brenda Motheral, BPharm, MBA, PhD
Connecting Statewide Health Information Technology Strategy to Payment Reform
John S. Toussaint, MD; Christopher Queram, MA; and Josephine W. Musser
Health Information Technology and Physicians' Perceptions of Healthcare Quality
Hai Fang, PhD, MPH; Karen L. Peifer, PhD, MPH, RN; Jie Chen, PhD; and John A. Rizzo, PhD
COPD-Related Healthcare Utilization and Costs After Discharge From a Hospitalization or Emergency Department Visit on a Regimen of Fluticasone Propionate-Salmeterol Combination Versus Other Maintenanc
Anand A. Dalal, PhD, MBA; Manan Shah, PhD; Anna O. D'Souza, PhD; and Douglas W. Mapel, MD
Telemonitoring With Case Management for Seniors With Heart Failure
Marcia J. Wade, MD, FCCP, MMM; Akshay S. Desai, MD, MPH; Claire M. Spettell, PhD; Aaron D. Snyder, BA; Virginia McGowan-Stackewicz, RN, CCM; Paula J. Kummer, RN, BA; Maureen C. Maccoy, RN, MBA; and Ra

Improving Endoscopy Completion: Effectiveness of an Interactive Voice Response System

Joan M. Griffin, PhD; Erin M. Hulbert, MS; Sally W. Vernon, PhD; David Nelson, PhD; Emily M. Hagel, MS; Sean Nugent, BA; Alisha Baines Simon, MS; Ann Bangerter, BS; and Michelle van Ryn, PhD
An interactive voice response system is as effective as nurse phone calls for ensuring that patients attend appointments and are adequately prepared for endoscopy examinations.
Automation of routine clinic processes using technology is often considered a method for reducing costs, especially if the processes include expensive personnel time. If IVR systems are more efficient and costs are significantly lower relative to NDCs, even small differences in patient outcomes may be meaningful for clinics. A recent randomized trial tested whether providing an educational and motivational message to patients via IVR was as effective as no intervention in promoting the initiation of CRC screening and found no statistically significant difference between the control and intervention groups.31 Our study is the first to date to evaluate the use of IVR to deliver both appointment reminder and educational information after an appointment for CRC testing is made. It is also the first to compare its effectiveness with person-to-person calls having identical message content. While the IVR system may lead to equally effective outcomes, we found that more patients who received the NDC had very positive perceptions about the call, while more patients who received the IVR message had neutral perceptions about the call. Because satisfaction reports are often positively skewed, differences between neutral, positive, and very positive perceptions might represent a meaningful degree of negative reaction. Therefore, while the IVR system may be equally effective as NDCs, we conclude that additional work to improve patient acceptability of messaging systems is needed to reduce high no-show and cancellation rates for endoscopy examinations.

This study had notable strengths. First, in addition to assessing endoscopy appointment outcomes, we were able to assess satisfaction with the intervention from the patient survey. Even with the advantages that IVR affords, such as flexible calling times, repetition of information, and supplemental messages, we found that patients had more neutral perceptions of IVR messages than of NDCs. Understanding whether patients will accept information in a specific format and whether the benefit of an automated system outweighs the effort and expense of delivering messages personally repnresents critical information for clinicians and managers when considering technological innovations to improve services. Second, throughout the course of the study, several practice changes were made to improve patient care, including slight changes in preparation materials (the addition of another laxative for colonoscopy preparation) and preparation instructions (prescription of the last dose of laxative the morning of the examination), and broader use of colonoscopy for screening purposes. Despite these changes, which were made across clinics and were equally distributed across intervention arms, the IVR system was as effective as NDCs, suggesting that the IVR system is flexible enough for a dynamic clinical environment.

The study also had several limitations. First, with options for multiple call attempts, the IVR group had more opportunities to receive messages, but it is unclear without data on the length of the NDCs whether patients engaged with nurses for longer periods than patients spent receiving IVR messages. Second, it was not feasible to include another intervention condition with no phone call, which would have provided data to determine if any form of preappointment prompting is effective, although previous meta-analysis and systematic review show that reminder calls are effective and should be the standard of care.38,39 Third, the procedure in this setting for scheduling appointments is based on clinic availability and not on patient availability. Therefore, it is possible that other solutions not tested herein, such as flexibility and convenience in scheduling or options for opting in or opting out of the call after the appointment reminder, would help improve overall completion rates.

We conclude that an IVR system is as effective as NDCs for ensuring that patients attend appointments and are adequately prepared for endoscopy examinations. However, strategies to increase patient satisfaction, including additional options integrated into IVR systems, may help improve these outcomes.

With appointment attendance and preparation adherence rates only near 60% across all study conditions, a combination of different approaches may be necessary to improve endoscopy completion. A potential application of an IVR system may be to shift staff effort from preprocedure education phone calls for all individuals with scheduled procedures to more intensive outreach only to those individuals identified before referral or through medical record review with increased likelihood of appointment nonattendance. The less intensive IVR technology could then be used for all other patients.

Author Affiliations: From the Center for Chronic Disease Outcomes Research (JMG, EMH, DN, EMH, SN, ABS, AB), Minneapolis Veterans Affairs Medical Center, Minneapolis, MN; Department of General Internal Medicine (JMG, DN), University of Minnesota School of Medicine, Minneapolis, MN; Division of Health Promotion and Behavioral Sciences (SWV), University of Texas–Houston School of Public Health, Houston, TX; and Department of Family Medicine and Community Health (MVR), University of Minnesota School of Medicine, Minneapolis, MN.


Funding Source: This study is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, IIR 03-295. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

 

Author Disclosures: The authors (JMG, EMH, SWV, DN, EMH, SN, ABS, AB, MVR) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

 

Authorship Information: Concept and design (JMG, SWV, DN, SN, MVR); acquisition of data (JMG, SN, ABS, AB, MVR); analysis and interpretation of data (JMG, Ms Hulbert, SWV, DN, Ms Hagel, SN, ABS, AB, MVR); drafting of the manuscript (JMG, Ms Hulbert, SWV, DN, Ms Hagel, SN); critical revision of the manuscript for important intellectual content (JMG, SWV, DN, Ms Hagel, ABS, MVR); statistical analysis (JMG, DN, Ms Hagel); provision of study materials or patients (JMG); obtaining funding (JMG, DN,MVR); administrative, technical, or logistic support (JMG, Ms Hulbert, SN, ABS, AB); and supervision (JMG).

 

Address correspondence to: Joan M. Griffin, PhD, Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center (152/3E-109), One Veterans Dr, Minneapolis, MN 55417. E-mail: joan.griffin2@va.gov.

1. American Cancer Society. Cancer Facts & Figures 2009. Atlanta, GA: American Cancer Society; 2009.


2. US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;149(9):627-637.


3. Meissner HI, Breen N, Klabunde CN, Vernon SW. Patterns of colorectal cancer screening uptake among men and women in the United States. Cancer Epidemiol Biomarkers Prev. 2006;15(2):389-394.


4. Fisher DA, Jeffreys A, Coffman CJ, Fasanella K. Barriers to full colon evaluation for a positive fecal occult blood test. Cancer Epidemiol Biomarkers Prev. 2006;15(6):1232-1235.


5. Bazargan M, Ani C, Bazargan-Hejazi S, Baker RS, Bastani R. Colorectal cancer screening among underserved minority population: discrepancy between physicians’ recommended, scheduled, and completed tests. Patient Educ Couns. 2009;76(2):240-247.


6. Dykes C, Cash BD. Key safety issues of bowel preparations for colonoscopy and importance of adequate hydration. Gastroenterol Nurs. 2008;31(1):30-35.


7. McCaffery K, Borril J, Williamson S, et al. Declining the offer of flexible sigmoidoscopy screening for bowel cancer: a qualitative investigation of the decision-making process. Soc Sci Med. 2001;53(5):679-691.

 

8. Mladen DM, Dragoslav MP, Sanja Z, Bozidar B, Snezana D. Problems in screening colorectal cancer in the elderly. World J Gastroenterol. 2003;9(10):2335-2337.


9. Wardle J, Miles A, Atkin W. Gender differences in utilization of colorectal cancer screening. J Med Screen. 2005;12(1):20-27.

 

10. Murdock A, Rodgers C, Lindsay H, Tham TC. Why do patients not keep their appointments? prospective study in a gastroenterology outpatient clinic. J R Soc Med. 2002;95(6):284-286.

 

11. Lee CS, McCormick PA. Telephone reminders to reduce non-attendance rate for endoscopy. J R Soc Med. 2003;96(11):547-548.

 

12. Kremers SP, Mesters I, Pladdet IE, van den Borne B, Stockbrügger RW. Participation in a sigmoidoscopic colorectal cancer screening program: a pilot study. Cancer Epidemiol Biomarkers Prev. 2000;9(10):1127-1130.

 


13. Vernon SW, Myers RE, Tilley BC. Development and validation of an instrument to measure factors related to colorectal cancer screening adherence. Cancer Epidemiol Biomarkers Prev. 1997;6(10):825-832.

 

14. Abuksis G, Mor M, Segal N, et al. A patient education program is cost-effective for preventing failure of endoscopic procedures in a gastroenterology department. Am J Gastroenterol. 2001;96(6):1786-1790.


15. Coombes JM, Steiner JF, Bekelman DB, Prochazka AV, Denberg TD. Clinical outcomes associated with attempts to educate patients about lower endoscopy: a narrative review. J Community Health. 2008; 33(3):149-157.


16. McBride CM, Rimer BK. Using the telephone to improve health behavior and health service delivery. Patient Educ Couns. 1999;37(1):3-18.

 

17. Piette JD. Interactive voice response systems in the diagnosis and management of chronic disease. Am J Manag Care. 2000;6(7):817-827.

 

18. Morrow D, Leirer VO, Carver LM, Tanke ED, McNally AD. Repetition improves older and younger adult memory for automated appointment messages. Hum Factors. 1999;41(2):194-204.

 

19. Christensen AA, Lugo RA, Yamashiro DK. The effect of confirmation calls on appointment-keeping behavior of patients in a children’s hospital dental clinic. Pediatr Dent. 2001;23(6):495-498.

 

20. Dini EF, Linkins RW, Chaney M. Effectiveness of computer-generated telephone messages in increasing clinic visits. Arch Pediatr Adolesc Med. 1995;149(8):902-905.

 

21. Dini EF, Linkins RW, Sigafoos J. The impact of computer-generated messages on childhood immunization coverage [published correction appears in Am J Prev Med. 2000;19(1):68-70]. Am J Prev Med. 2000;18(2):132-139.


22. Fishman P, Taplin S, Meyer D, Barlow W. Cost-effectiveness of strategies to enhance mammography use. Eff Clin Pract. 2000;3(5):213-220.

 

23. Lythgoe MS. Computerized telephone reminder system facilitates wellness and prevention. J Med Pract Manage. 1999;14(4):204-208.

 

24. O’Brien G, Lazebnik R. Telephone call reminders and attendance in an adolescent clinic. Pediatrics. 1998;101(6):E6. http://pediatrics.aappublications.org/cgi/content/full/101/6/e6. Accessed February 11, 2011.


25. O’Connell JM, Towles W, Yin M, Malakar CL. Patient decision making: use of and adherence to telephone-based nurse triage recommendations. Med Decis Making. 2002;22(14):309-317.

 

26. Racelis MC, Lombardo K, Verdin J. Impact of telephone reinforcement of risk reduction education on patient compliance. J Vasc Nurs. 1998;16(1):16-20.


27. Revere D, Dunbar PJ. Review of computer-generated outpatient health behavior interventions: clinical encounters “in absentia.” J Am Med Inform Assoc. 2001;8(1):62-79.


28. Piette JD, Weinberger M, Kraemer FB, McPhee SJ. Impact of automated calls with nurse follow-up on diabetes treatment outcomes in a Department of Veterans Affairs Health Care System: a randomized controlled trial. Diabetes Care. 2001;24(2):202-208.

 

29. Piette JD. Patient education via automated calls: a study of English and Spanish speakers with diabetes. Am J Prev Med. 1999;17(2):138-141.


30. Alemi F, Stephens RC, Javalghi RG, Dyches H, Butts J, Ghadiri A. A randomized trial of a telecommunications network for pregnant women who use cocaine. Med Care. 1996;34(10)(suppl):OS10-OS20.

 

31. Simon SR, Zhang F, Soumerai SB, et al. Failure of automated telephone outreach with speech recognition to improve colorectal cancer screening: a randomized controlled trial. Arch Intern Med. 2010;170(3): 264-270.


32. Janz NK, Champion VL, Strecher VJ. The health belief model. In: Glanz K, Rimer BK, Marcus Lewis F, eds. Health Behavior and Health Education: Theory, Research, and Practice. 3rd ed. San Francisco, CA: Jossey-Bass; 2002.


33. Andreasen A. Marketing Social Change: Changing Behavior to Promote Health, Social Development, and the Environment. San Francisco, CA: Jossey-Bass; 1995.

 

34. Brown JD, Einseidel EF. Public health campaigns: mass media strategies. In: Berlin RE, Donohew L, eds. Communication and Health: Systems and Applications. Hillsdale, NJ: Lawrence Erlbaum; 1990:153-170.


35. Dillman DA, Smyth J, Christian LM. Internet, Mail and Mixed-Mode Surveys: The Tailored Design Method. Hoboken, NJ: Wiley; 2008.

 

36. Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P; CONSORT Group. Extending the CONSORT Statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148(4):295-309.

 

37. Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P; CONSORT Group. Methods and processes of the CONSORT Group: example of an extension for trials assessing nonpharmacologic treatments. Ann Intern Med. 2008;148(4):W60-W66.

 


38. Jacobson VJ, Szilagyi P. Patient reminder and patient recall systems to improve immunization rates. Cochrane Database Syst Rev. 2005;(3):CD003941.

 


39. Krishna S, Balas EA, Boren SA, Maglaveras N. Patient acceptance of educational voice messages: a review of controlled clinical studies. Methods Inf Med. 2002;41(5):360-369.

PDF
 
Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up