For medical practices, a major challenge is managing the hundreds of telephone calls received daily, many of which are about new or worsening medical symptoms. Particularly difficult are calls from persons with little or no medical training about frail older persons living at home or in assisted living (AL) communities. Incoming calls are typically answered by a receptionist with little medical training, who takes basic information and passes the call to an office nurse, who resolves the call with occasional provider backup. Consistent, high-quality management and documentation of these telephone contacts is a formidable task for both medical offices and AL communities. Standard protocols and triage systems exist for obstetrics, pediatrics, and general adult medicine, but no geriatric-specific products exist, and integration of telephone information-gathering systems with electronic health records (EHRs) is rudimentary. Thus, a growing need exists in the healthcare market for evidence-based, user-friendly systems to guide office receptionists and nurses in the management of telephone contacts about geriatric patients. The proposed project will partner Keona Health, a small business specializing in internet-based communication between patients and medical practices about medical symptoms, with key members of an NINR-funded project at the University of North Carolina at Chapel Hill (UNC) that is developing evidence- based materials for family caregivers about medical symptoms in persons with dementia. We propose to: (1) expand Keona's existing electronic platform to offer a message management system for office receptionists, nurses, and medical providers that integrates with office EHRs;(2) create one general and five symptom- specific problem management protocols about common symptoms in older persons, incorporating them into the electronic message management system for medical office staff and paper protocols for AL staff;and (3) conduct a pre-post evaluation of the system in a busy primary care medical practice for seniors and three AL communities it serves, evaluating both system feasibility (use, functionality, call time and cost, barriers and facilitators of use) and outcomes of system use (documentation, self-efficacy of AL staff and of office receptionists and nurses, and caller satisfaction. Innovative features include targeting the growing geriatric market;rapid, consistent data collection;evidence-based guidance for staff;improved documentation of every call;and the potential to increase efficiency and reduce cost. Successful achievement of this project could lead to a call management system with large commercial potential - addressing the hundreds of millions of telephone calls made for geriatric health concerns every year.

Public Health Relevance

The proposed project builds a communication management system that will help medical offices and assisted living communities better manage telephone communications from geriatric patients. The cornerstone of the system will be guides for front-line personnel, especially receptionists and nurses, in following best practices in data intake and recommendations. This system has the potential to make significant improvements to the handling of triage calls, including improved responsiveness, better documentation, improved patient safety, and lower cost per encounter. This phase one project will develop 5 protocols and run a before-after observational study to demonstrate the feasibility and outcomes of their use.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Small Business Technology Transfer (STTR) Grants - Phase I (R41)
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Special Emphasis Panel (ZRG1-HDM-W (10))
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Diana, Augusto
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Keona Health, Inc.
Chapel Hill
United States
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Crnich, Christopher J; Jump, Robin; Trautner, Barbara et al. (2015) Optimizing Antibiotic Stewardship in Nursing Homes: A Narrative Review and Recommendations for Improvement. Drugs Aging 32:699-716