Lessons Learned From Examining After-Hours Call Patterns

Marvicsin, Donna; Eagle, Megan; Munro, Michelle L.; Harlow-Rosentraub, Karen; Pohl, Joanne M.

doi:10.1016/j.nurpra.2014.07.042

Cited by 3 publications

(7 citation statements)

References 32 publications

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“…The approach to identify articles across each PCMH domain led to difficulty finding articles directly addressing primary care, the topic area, and the outcomes of cost and utilization. For instance, many other studies related to access (e.g., nurse consultation lines [5152], patient portals [535455]) were available but did not meet inclusion criteria due to the larger context of these studies (e.g., in health systems, rather than solely in primary care practices). This led to targeted searches suggested by stakeholders or from references and related sources, which did not allow us to perform a systematic review in every area.…”

Section: Discussionmentioning

confidence: 99%

Defining High Value Elements for Reducing Cost and Utilization in Patient-Centered Medical Homes for the TOPMED Trial

Anastas

Wagner

Ross

et al. 2019

eGEMs

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Introduction: Like most patient-centered medical home (PCMH) models, Oregon’s program, the Patient-Centered Primary Care Home (PCPCH), aims to improve care while reducing costs; however, previous work shows that PCMH models do not uniformly achieve desired outcomes. Our objective was to describe a process for refining PCMH models to identify high value elements (HVEs) that reduce cost and utilization. Methods: We performed a targeted literature review of each PCPCH core attribute. Value-related concepts and their metrics were abstracted, and studies were assessed for relevance and strength of evidence. Focus groups were held with stakeholders and patients, and themes related to each attribute were identified; calculation of HVE attainment versus PCPCH criteria were completed on eight primary care clinics. Analyses consisted of descriptive statistics and criterion validity with stakeholder input. Results: 2,126 abstracts were reviewed; 22 met inclusion criteria. From these articles and focus groups of stakeholders/experts (n = 49; 4 groups) and patients (n = 7; 1 group), 12 HVEs were identified that may reduce cost and utilization. At baseline, clinics achieved, on average, 31.3 percent HVE levels compared to an average of 87.9 percent of the 35 PCMH measures. Discussion: A subset of measures from the PCPCH model were identified as “high value” in reducing cost and utilization. HVE performance was significantly lower than standard measures, and may better calibrate clinic ability to reduce costs. Conclusion: Through literature review and stakeholder engagement, we created a novel set of high value elements for advanced primary care likely to be more related to cost and utilization than other models.

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Section: Discussionmentioning

confidence: 99%

Defining High Value Elements for Reducing Cost and Utilization in Patient-Centered Medical Homes for the TOPMED Trial

Anastas

Wagner

Ross

et al. 2019

eGEMs

View full text Add to dashboard Cite

show abstract

“…Marvicsin et al. () described utilization of an on‐call encounter template for NMHC on‐call encounters. Despite this, during faculty evaluation of the notes the most frequently missed components of the history were family and social history, and barriers to adherence.…”

Section: Discussion/implicationsmentioning

confidence: 99%

“…The assignment provides innumerable opportunities for expansion including development of additional patient scenarios to include conditions that will facilitate authenticity, consistency, and assortment in student encounters. Common reasons for after‐hours contact with the primary care provider include: fever, abdominal pain, pregnancy issues, injury, chest pain, upper respiratory illness, allergic conditions (Marvicsin et al., ). We currently have standard scenarios for several of these conditions with more in development.…”

Section: Discussionmentioning

confidence: 99%

“…Marvicsin, Eagle, Munro, Harlow‐Rosentraub, and Pohl () explored the after‐hours call patterns at two primary care nurse‐managed health centers (NMHC) specifically focusing on patient characteristics, level of emergency department (ED) visit averted, and cost saving incurred because of averted ED visit. The 1‐year analysis concluded that 50% of the after‐hours calls averted ED visits, resulting in a significant healthcare cost savings (Marvicsin et al., ). Only 7% of calls received were referred to the ED, and analysis of the referrals suggests that ED referral was appropriate.…”

Section: Background/purposementioning

confidence: 99%

“…Only 7% of calls received were referred to the ED, and analysis of the referrals suggests that ED referral was appropriate. A significant finding was that 43% of calls received were related to nonurgent concerns leading the NP to provide advice, reassurance, or clarification of a prescription or laboratory result (Marvicsin et al., ). These results are consistent with others (e.g., Bogden, Green, Swanson, Gabow, & Dart, ; Lattimer et al., ; O'Malley, ) supporting the need and healthcare cost savings with appropriate after‐hours access.…”

Section: Background/purposementioning

confidence: 99%

See 2 more Smart Citations

After-hours/on-call experience during primary care nurse practitioner education utilizing standard scenarios and simulated patients

Kelly

Blunt

Nestor

2017

Journal of the American Association of Nurse Practitioners

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Background and purpose Few nurse practitioner (NP) programs include an after‐hours/on‐call component in their clinical preparation of NP students. This role is expected in many primary and specialty care practices, and is one that students feel unprepared to competently navigate. Methods Utilizing simulated callers as patients or parents, NP students participated in a simulated after‐hours/on‐call experience that included receiving the call, managing the patient, and submitting documentation of the encounter. Students completed pre‐ and postparticipation evaluations, and were evaluated by the simulated patient callers and faculty using standardized evaluation tools. Conclusions NP students rated the experience as an educationally valuable experience despite feeling anxious and nervous about the experience. Several essential skills were identified including critical thinking, clear communication, self‐confidence, and access to resources. After participation NP students were more receptive to an NP position with an on‐call component. Implications for practice Inclusion of a simulated on‐call experience is a feasible component of NP education and should be added to the NP curriculum.

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Consultation With Nurse Practitioners Over the Telephone in Prison Health

Schoenwald¹,

Ponting²,

How³

et al. 2022

The Journal for Nurse Practitioners

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The nurse practitioner (NP) role presents opportunities to improve access to care for the management of those in prisons, including telephone consultations with the nursing team after hours. This qualitative study used semistructured interviews with prison nurses to gain insights into the role and capability of NPs to provide telephone advice and direction within an after-hours prison health model of care. Three main themes emerged: value and capability, nursing team, and safety of the on-call model. This study adds to our understanding of the capability of the NP in the prison setting and the value of an on-call model of care within a primary team structure.

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Lessons Learned From Examining After-Hours Call Patterns

Cited by 3 publications

References 32 publications

Defining High Value Elements for Reducing Cost and Utilization in Patient-Centered Medical Homes for the TOPMED Trial

Defining High Value Elements for Reducing Cost and Utilization in Patient-Centered Medical Homes for the TOPMED Trial

After-hours/on-call experience during primary care nurse practitioner education utilizing standard scenarios and simulated patients

Consultation With Nurse Practitioners Over the Telephone in Prison Health

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