Joel C Boggan1,2, John Paul Shoup3, John D Whited4,5, Elizabeth Van Voorhees6,7, Adelaide M Gordon5, Sharron Rushton8, Allison A Lewinski5, Amir A Tabriz9, Soheir Adam10, Jessica Fulton6,7, Andrzej S Kosinski11,12, Megan G Van Noord13, John W Williams4,5, Karen M Goldstein4,5, Jennifer M Gierisch4,5,14. 1. Hospital Medicine Team (111M), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA. Joel.boggan@va.gov. 2. Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA. Joel.boggan@va.gov. 3. BJC Medical Group, St. Louis, MO, USA. 4. Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA. 5. Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA. 6. Hospital Medicine Team (111M), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA. 7. Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA. 8. School of Nursing, Duke University, Durham, NC, USA. 9. Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 10. Department of Medicine, Division of Hematology, Duke University, Durham, NC, USA. 11. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA. 12. Duke Clinical Research Institute, Durham, NC, USA. 13. University of California at Davis, Davis, CA, USA. 14. Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
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).
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).
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