Utilization patterns and efficiency gains from use of a fully EHR-integrated COVID-19 self-triage and self-scheduling tool: a retrospective analysis

Judson, Timothy; Pierce, Logan; Tutman, Avi; Mourad, Michelle; Neinstein, Aaron B.; Shuler, Gina; Gonzales, Ralph; Odisho, Anobel Y.

doi:10.1093/jamia/ocac161

Cited by 6 publications

(7 citation statements)

References 27 publications

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Section: Discussionmentioning

confidence: 99%

“…This result is consistent with findings from self-triage and self-scheduling of COVID PCR testing which showed savings of thousands of hours of nurse triage time and staff scheduler time. 5,12 It was out of the scope of this study to fully explore NVC that was associated with self-triage. However, our limited content review of over 400 patient-initiated messages showed that almost a third of them had content containing the terms "antibiotics" and "infection."…”

Section: Practice Implicationsmentioning

confidence: 99%

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Self-Triage Use, Subsequent Healthcare Utilization, and Diagnoses: A Retrospective Study of Process and Clinical Outcomes Following Self-Triage and Self-Scheduling for Ear or Hearing Symptoms

North

Jensen

Stroebel

et al. 2023

Health Services Research and Managerial Epidemiology

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Background Self-triage is becoming more widespread, but little is known about the people who are using online self-triage tools and their outcomes. For self-triage researchers, there are significant barriers to capturing subsequent healthcare outcomes. Our integrated healthcare system was able to capture subsequent healthcare utilization of individuals who used self-triage integrated with self-scheduling of provider visits. Methods We retrospectively examined healthcare utilization and diagnoses after patients had used self-triage and self-scheduling for ear or hearing symptoms. Outcomes and counts of office visits, telemedicine interactions, emergency department visits, and hospitalizations were captured. Diagnosis codes associated with subsequent provider visits were dichotomously categorized as being associated with ear or hearing concerns or not. Nonvisit care encounters of patient-initiated messages, nurse triage calls, and clinical communications were also captured. Results For 2168 self-triage uses, we were able to capture subsequent healthcare encounters within 7 days of the self-triage for 80.5% (1745/2168). In subsequent 1092 office visits with diagnoses, 83.1% (891/1092) of the uses were associated with relevant ear, nose and throat diagnoses. Only 0.24% (4/1662) of patients with captured outcomes were associated with a hospitalization within 7 days. Self-triage resulted in a self-scheduled office visit in 7.2% (126/1745). Office visits resulting from a self-scheduled visit had significantly fewer combined non-visit care encounters per office visit (fewer combined nurse triage calls, patient messages, and clinical communication messages) than office visits that were not self-scheduled (−0.51; 95% CI, −0.72 to −0.29; P < .0001). Conclusion In an appropriate healthcare setting, self-triage outcomes can be captured in a high percentage of uses to examine for safety, patient adherence to recommendations, and efficiency of self-triage. With the ear or hearing self-triage, most uses had subsequent visit diagnoses relevant to ear or hearing, so most patients appeared to be selecting the appropriate self-triage pathway for their symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Practice Implicationsmentioning

confidence: 99%

Self-Triage Use, Subsequent Healthcare Utilization, and Diagnoses: A Retrospective Study of Process and Clinical Outcomes Following Self-Triage and Self-Scheduling for Ear or Hearing Symptoms

North

Jensen

Stroebel

et al. 2023

Health Services Research and Managerial Epidemiology

View full text Add to dashboard Cite

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“… 10 Judson et al at University of California San Francisco also found significant time savings with self-scheduling of COVID visits. 9 Our findings show the potential to extend self-scheduling efficiencies well beyond COVID testing.…”

Section: Discussionmentioning

confidence: 73%

“…Patients are self-scheduling medical appointments with increasing regularity. Self-scheduling use cases have been published for community-based practices, 1 , 2 dermatology appointments, 3 , 4 screening mammograms, 5 , 6 well-child visits, 7 COVID testing, 8 – 10 and sexual health appointments. 11 Zocdoc and Lybrate are e-health services operating in the US and internationally that schedule patients online with providers by focus on their practice, specialty, and location.…”

Section: Introductionmentioning

confidence: 99%

Self-scheduling in a Large Multispecialty and Multisite Clinic: A Retrospective, Longitudinal Examination of Multiple Self-Scheduled Visit Types

North,

Buss,

Nelson

et al. 2024

Health Services Research and Managerial Epidemiology

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Background Self-scheduling of medical visits is becoming available at many medical institutions. We aimed to examine the self-scheduled visit counts and rate of growth of self-scheduled visits in a multispecialty practice. Methods For 85 weeks extending from January 1, 2022 through August 24, 2023, we examined self-scheduled visit counts for over 1500 self-scheduled visit types. We compared completed self-scheduled visit counts to all scheduled completed visit counts for the same visit types. We collected counts of the most frequently self-scheduled visit types for each week and examined the change over time. We also determined the proportion that each visit type was self-scheduled. Results There were 20,769 699 completed visits during the course of the study that met the criteria for inclusion. Self-scheduled visits accounted for 4.0% of all completed visits (838 592/20,769 699). Over the 85-week span, self-scheduled visits rose from 3.0% to 5.3% of the total. There were 1887 unique visit types that were associated with completed visits. There were just 6 appointment visit types of the total 1887 self-scheduled visit types that accounted for 50.7% of the total 838 592 self-scheduled visits. Those 6 visit types were a lab blood test visit (19.5%, 163 K visits), two Family Medicine office visit types (13.0%, 109 K visits), a screening mammogram visit type (6.6%, 55 K visits), a scheduled express care visit type (6%, 50 K visits) and a COVID immunization visit type (5.7%, 48 K visits). Twenty-one visit types that were self-scheduled accounted for 75% of the total self-scheduled visits. Four seasonal visits, accounting for 10.6% of the total self-scheduled visits, were responsible for almost all the non-linear change in self-scheduling. Conclusion Self-scheduling accounted for a small but growing percent of all outpatient scheduled visits in a multispecialty, multisite practice. A wide range of visit types can be successfully self-scheduled.

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“…To help reduce ED visits and make COVID care and detection more efficient, Mayo Clinic and the University of California, San Francisco successfully developed online self-triage and self-scheduling systems for COVID that diverted asymptomatic and symptomatic patients without severe symptoms to outpatient testing, thus avoiding ED visits. [10][11][12] These interventions for COVID demonstrated the potential for broader interventions to decrease unnecessary ED visits.…”

Section: Introductionmentioning

confidence: 99%

Hospitalization Risk Associated With Emergency Department Reasons for Visit and Patient Age: A Retrospective Evaluation of National Emergency Department Survey Data to Help Identify Potentially Avoidable Emergency Department Visits

North,

Garrison,

Jensen

et al. 2023

Health Services Research and Managerial Epidemiology

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Background Patients often present to emergency departments (EDs) with concerns that do not require emergency care. Self-triage and other interventions may help some patients decide whether they should be seen in the ED. Symptoms associated with low risk of hospitalization can be identified in national ED data and can inform the design of interventions to reduce avoidable ED visits. Methods We used the National Hospital Ambulatory Medical Care Survey (NHAMCS) data from the United States National Health Care Statistics (NHCS) division of the Centers for Disease Control and Prevention (CDC). The ED datasets from 2011 through 2020 were combined. Primary reasons for ED visit and the binary field for hospital admission from the ED were used to estimate the proportion of ED patients admitted to the hospital for each reason for visit and age category. Results There were 221,027 surveyed ED visits during the 10-year data collection with 736 different primary reasons for visit and 23,228 hospitalizations. There were 145 million estimated hospitalizations from 1.37 billion estimated ED visits (10.6%). Inclusion criteria for this study were reasons for visit which had at least 30 ED visits in the sample; there were 396 separate reasons for visit which met this criteria. Of these 396 reasons for visit, 97 had admission percentages less than 2% and another 52 had hospital admissions estimated between 2% and 4%. However, there was a significant increase in hospitalizations within many of the ED reasons for visit in older adults. Conclusion Reasons for visit from national ED data can be ranked by hospitalization risk. Low-risk symptoms may help healthcare institutions identify potentially avoidable ED visits. Healthcare systems can use this information to help manage potentially avoidable ED visits with interventions designed to apply to their patient population and healthcare access.

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Utilization patterns and efficiency gains from use of a fully EHR-integrated COVID-19 self-triage and self-scheduling tool: a retrospective analysis

Cited by 6 publications

References 27 publications

Self-Triage Use, Subsequent Healthcare Utilization, and Diagnoses: A Retrospective Study of Process and Clinical Outcomes Following Self-Triage and Self-Scheduling for Ear or Hearing Symptoms

Self-Triage Use, Subsequent Healthcare Utilization, and Diagnoses: A Retrospective Study of Process and Clinical Outcomes Following Self-Triage and Self-Scheduling for Ear or Hearing Symptoms

Self-scheduling in a Large Multispecialty and Multisite Clinic: A Retrospective, Longitudinal Examination of Multiple Self-Scheduled Visit Types

Hospitalization Risk Associated With Emergency Department Reasons for Visit and Patient Age: A Retrospective Evaluation of National Emergency Department Survey Data to Help Identify Potentially Avoidable Emergency Department Visits

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