Effectiveness of Acute Care Remote Triage Systems: a Systematic Review.
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2020-07
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Abstract
Background
Technology-based systems can facilitate remote decision-making to triage patients to the appropriate level of care. Despite technologic advances, the effects of implementation of these systems on patient and utilization outcomes are unclear. We evaluated the effects of remote triage systems on healthcare utilization, case resolution, and patient safety outcomes.Methods
English-language searches of MEDLINE (via PubMed), EMBASE, and CINAHL were performed from inception until July 2018. Randomized and nonrandomized comparative studies of remote triage services that reported healthcare utilization, case resolution, and patient safety outcomes were included. Two reviewers assessed study and intervention characteristics independently for study quality, strength of evidence, and risk of bias.Results
The literature search identified 5026 articles, of which eight met eligibility criteria. Five randomized, two controlled before-and-after, and one interrupted time series study assessed 3 categories of remote triage services: mode of delivery, triage professional type, and system organizational level. No study evaluated any other delivery mode other than telephone and in-person. Meta-analyses were unable to be performed because of study design and outcome heterogeneity; therefore, we narratively synthesized data. Overall, most studies did not demonstrate a decrease in primary care (PC) or emergency department (ED) utilization, with some studies showing a significant increase. Evidence suggested local, practice-based triage systems have greater case resolution and refer fewer patients to PC or ED services than regional/national systems. No study identified statistically significant differences in safety outcomes.Conclusion
Our review found limited evidence that remote triage reduces the burden of PC or ED utilization. However, remote triage by telephone can produce a high rate of call resolution and appears to be safe. Further study of other remote triage modalities is needed to realize the promise of remote triage services in optimizing healthcare outcomes.Protocol registration
This study was registered and followed a published protocol (PROSPERO: CRD42019112262).Type
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Publication Info
Boggan, Joel C, John Paul Shoup, John D Whited, Elizabeth Van Voorhees, Adelaide M Gordon, Sharron Rushton, Allison A Lewinski, Amir A Tabriz, et al. (2020). Effectiveness of Acute Care Remote Triage Systems: a Systematic Review. Journal of general internal medicine, 35(7). pp. 2136–2145. 10.1007/s11606-019-05585-4 Retrieved from https://hdl.handle.net/10161/23331.
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Scholars@Duke
Joel Boggan
I am a hospital medicine physician interested in quality improvement, patient safety, and medical education across the UME and GME environments. My current projects include work on readmissions, inpatient quality and patient experience measures, appropriate utilization of inpatient resources, systematic reviews of topics related to healthcare quality, and artificial intelligence in medical education. Alongside this work, I serve as the lead mentor for our Durham VA Chief Resident in Quality and Safety within the Department of Medicine and the Program Director for the Duke University Hospital CRQS.
As Associate Program Director for Quality Improvement and Patient Safety in the Duke Internal Medicine Residency Program, I oversee QI and safety education and projects for our residents and help co-lead our Residency Patient Safety and Quality Council. Additionally, I supervise housestaff and students on our general medicine wards, precept housestaff evidence-based medicine resident reports, and serve as a small group leader for our second-year medical student Clinical Skills Course. Finally, I lead our Innovation Sciences thread as part of the ongoing School of Medicine Curriculum Innovation Initiative and serve as a co-course director for our QMDM II (Biostatistics) course.
Elizabeth E. Van Voorhees
Interest in understanding mechanisms and advancing treatment of anger and aggression in veterans with trauma-related psychopathology, including posttraumatic stress disorder. Specific interests in integrating mHealth applications and sensor technology into the therapeutic process; sex/gender differences in the experience, expression, and treatment of anger and aggression associated with trauma; and “moral injury” associated with trauma.
Sharron Rushton
Sharron "Shari" Rushton, DNP, MS, RN, CCM, CNE joined the Duke University School of Nursing (DUSON) faculty in 2011. She earned her Bachelor of Science in Nursing from the University of Iowa, a Master of Biomedical Science in Physiology from the Mayo Graduate School, and both an Master of Science in Nursing and Doctor of Nursing Practice from DUSON. Her scholarly interests include translation of evidence in practice, care coordination/case management, population health, interprofessional education, and educational strategies. She teaches population health across graduate programs and evidence-based practice in the MSN Core.
Allison A. Lewinski
I am a health services researcher and implementation scientist with a joint appointment at the Duke University School of Nursing (DUSON) and the Durham Veterans Affairs Health Care System (VHA). My expertise spans diabetes distress, qualitative research methods, and virtual care delivery (including telehealth and digital health).
My research examines how virtual care interventions can reduce distress, improve self-management, expand access to evidence-based care, and enhance patient and population health outcomes. I focus on patient-, provider-, and system-level factors that influence the use and effectiveness of virtual care. This work has been funded by competitive grants, published in high-impact journals, presented at national conferences, and used to inform health system decision-making. I am frequently sought by colleagues locally and nationally for expertise in diabetes distress, qualitative methods, and virtual care strategies for grants, projects, and manuscripts.
I strive to improve outcomes for individuals with chronic illness by developing equitable, sustainable virtual care solutions and evaluating their implementation. To optimize these interventions, I apply qualitative and implementation science approaches to ensure alignment among patient needs, care modalities, disease states, and social contexts. My work addresses critical questions: for whom and for what purposes are these interventions effective, in which contexts, and at what points in the care continuum. Ultimately, my research advances the implementation and adoption of virtual care to reduce psychosocial distress and improve health outcomes through patient-clinician interactions and system-level innovations.
Soheir Saeed Adam
Jessica Jade Fulton
Clinical Practice:
I specialize in the assessment and treatment of issues common in patients and family members of patients with chronic, life-threatening, or terminal illness focusing on symptom management (e.g., pain, depression, anxiety) and end-of-life issues (e.g., suffering, anticipatory grief, existential angst). Additionally, I have expertise in the assessment and treatment of behavioral and psychological aspects of disability and chronic health conditions with interventions focused on increasing meaning, independence and choice, functional abilities, and social role participation.
Clinical Teaching:
I offer clinical training to Duke psychology and psychiatry trainees and am a member of the Durham VA Medical Center Psychology Training Program, supervising psychology residents on the Rehabilitation, Geriatric, Palliative, and Hospice Care Rotation.
Research interests:
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Health policy and systems research related to rehabilitation and palliative mental health services
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Psychological, sociocultural, interpersonal, and spiritual factors in chronic disease and life-threatening or terminal illness
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Prevention of and adjustment to amputation/limb loss
Karen M. Goldstein
Dr. Goldstein's research interests include women's health, cardiovascular risk reduction, evidence synthesis methodology and peer support.
Jennifer M. Gierisch
Jennifer Gierisch, PhD, is behavioral scientist and health services researcher. She is an Associate Professor in the Department of Population Heath Sciences and the Department of Medicine at Duke University. She is a core investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) where she serves as the leader of the Partnered Research Methods Core (PRESTO) and Director of the VA OAA Health Services Research Postdoctoral Fellowship. Dr. Gierisch also is the Co-Director of the Evidence Synthesis Program (VA ESP) at the Durham Veteran Affairs Health Care System. She also served as a faculty director of the Duke Clinical Translational Science Institute's Community Engaged Research Initiative (CeRi) for five years
Dr. Gierisch’s research focuses on three overarching areas: 1) behavioral research on the psychosocial factors that influence appropriate uptake and maintenance of complex health behaviors (eg., weight management, smoking cessation, cancer screening); 2) evidence synthesis on key health and healthcare topics to enhance uptake of evidence-based interventions to improve patient and health system outcomes; and 3) participatory and community engaged research approaches.
Area of expertise: health behavior, community-engaged research, evidence synthesis, intervention development, qualitative research
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