A Model for Effective and Efficient Hospice Care: Proactive Telephone-Based Enhancement of Life Through Excellent Caring, "TeleCaring" in Advanced Illness.

BACKGROUND: A community-based non-profit hospice provider implemented "TeleCaring" as a quality improvement intervention to identify and take action on patient or caregiver needs or concerns, such as uncontrolled symptoms or prescription problems. MEASURES: We assessed the rate of acceptance of the intervention, intensity of the intervention, escalations of calls from Specialists to Nurses, and the effect of the intervention on utilization of clinical services, clinical miles traveled, and family satisfaction with care. INTERVENTION: TeleCaring consisted of daily proactive phone calls to patients and caregivers by Specialists and Nurses. OUTCOMES: Eighty-eight percent of new home hospice patients accepted TeleCaring when offered. A total of 5.3% of calls by Specialists were escalated to Nurses. TeleCaring participants had lower utilization of clinical services compared with non-participants. Family satisfaction increased and clinical miles decreased across the organization after the implementation of TeleCaring. CONCLUSIONS/LESSONS LEARNED: TeleCaring is a viable method to proactively identify home hospice patient or caregiver needs and adjust clinical services accordingly.