Cost Friendly savings notification More timely (paper, despite - - PowerPoint PPT Presentation

Tiered system of DNA (did not attend) calls and letters

reminding patients when they are late for a scheduled INR test.

Prior to 2011, all reminders sent by mail Implemented Televox reminder calls in 2011 In 2014 we explored impact of this new technology

from 2 perspectives: patient compliance cost-savings

More timely delivery of reminder notices

People like to listen messages rather than

• pen mail

Friendly notification despite geographical location or travel

Cost savings (paper, postage, labor)

Response rate better with phone reminders

DNA Procedures

DNA lists managed by Administrative Team

DNA 1 call on second

business day after scheduled INR date

Bulk reschedule to one week

from previous date (2 weeks if notice mailed)

Daily Televox report

managed by Office Manager

Nurses involved at DNA 3, 4 and Final Discharge

Reminders created on

patient record for RN to follow-up:

• Investigate if INR available
• Call patient
• Inform physician and request

support, danger of potential discharge

• Documents status in Dawn

and hospital record

• RN makes final decision for

discharge

Lists of patients meeting criteria for DNA 1 and DNA 2 are queried each weekday. The rescheduling of patients calls up the “outbound Televox DNA House Call” procedure and documents the message on the Letters tab

The DNA reschedule event and non-attendance count

• n the patient record determines the choice of

routines for creating outbound messages Text file messages are created and exported to the individual DNA 1 and DNA 2 folders on the server (i.e., H:\DAWN INTERFACE\Outbound\Televox\DNA(X)

• A batch file merges all DNA 1 and DNA 2 messages into a single file
• The Partners file transfer protocol (FTP) process outputs the files to Televox
• An enterprise transaction manager schedules and monitors the entire process

Retrieves files from their secure FTP site daily and makes automated calls at a designated time

The Televox System Used By MGH AMS

• Uses a recorded human voice, sounds

crisp and professional. Messages are not personalized (staying compliant with HIPAA regulations)

• The missed INR reminder made via

TeleVox on 2nd business day following a scheduled INR date

Hi, this is a message for a member of your family. The Anticoagulation Management Service at the Massachusetts General Hospital has not received your INR. If you have not had your INR done, please do so by _reschedule date_. If you have had your INR please call 617-726-3919 and leave your first and last name and medical record number or date of birth. Include the name of the lab and the date you went for your INR. If you have any questions and wish to speak to someone in your native language, please call the interpreter services at 617-726-6966 and ask that an interpreter call our clinic. Thank you.

Called - No Answer Phone too busy Answered - Hung Up

Answered - No Response Out of Order Invalid phone number Answered - Repeated message Answering Machine

• During comprehensive educational session, patients receive explanation
• f our ‘reminder’ system, emphasizing safety
• Reminder calls translated into 8 different languages - serves our

culturally diverse population

5065 25 4 7 23 25 37 27 121 100 200 300 400 500 600 English Arabic Cambodian Chinese - Cantonese Chinese - Mandarin Italian Portuguese Russian Spanish

(Time period = 3 months, N=5334)

5065

DNA 1 Calls DNA 2 Calls

5 10 15 20 25 30 35 50 100 150 200 250 300 350 1 2 3 4 5 6 7 8 9 DNA2 English DNA2 Non-English 50 100 150 200 250 1000 2000 3000 4000 5000 6000 1 2 3 4 5 6 7 8 9 DNA1 English DNA1 Non- English

Key: 1 – No Answer 2 – Phone Busy 3 – Hung Up 4 – No Response 5 – Out of Order 6 – Invalid Phone 7 – Repeated Message 8 – Answer Machine 9 - Total

Identified a patient cohort with a scheduled INR date for a 1

month period of time, began 9/11/2014 and ended10/10/2014

Followed this patient cohort over time to ‘march’ through all

DNA levels. Observation ended 11/7/2014

Determined patients’ responses to DNA 1& 2 TeleVox

reminders and written notices (eg. Went for INR as requested)

• Data collected allowed:

1) precise patient response to DNA calls and notices 2) cost analysis of pre and post use of Televox

(data reflects details of a I week period)

INRs scheduled, 2272 356 92 34 4 3 or .8% 74.9% 91.2% 98.9% 99.2% 0% 20% 40% 60% 80% 100% 120% 500 1000 1500 2000 2500 Percent Response Patients/INRs scheduled over 7-day period Reminder Level Patients Response to Reminders

$0 $2,581 $14,965 $1,416 $14,965 $3,997

Pre Televox Post Televox Televox Cost Mail Costs* Total Costs

**

73% Savings

*Includes stationary & envelope costs, excludes labor costs ** Benefit from Partners pricing (economy of scale)

Patients respond positively to

Televox reminder calls

Phone calls are timely and

prevent further progression to DNA 3 and 4 levels (thus

improves patient monitoring and safety)

Significant cost savings

“…..For me, the phone messages have been far more

• effective. I do just about everything online and over the

phone now. Most of the stuff I get in the mail these days tends to be junk so I don’t pay attention to it. I usually see the date of my next test in the emails, but tend to forget about it until I get the phone call to remind me.”

Justin G.

This advanced technology enables our patients to receive DNA reminders on time and re-engage to avoid discharge from AMS

• Provide options

and enhance communications with patients

• Adapt and utilize

new technologies