Fig. 3.1
Characteristics of telephone activity 2011–2012. (High frequency telephone encounters in patients with IBD were associated with increased CRP C-reactive protein and ESR erythrocyte sedimentation rate elevation, prednisone and narcotic use, abdominal pain, psychiatric comorbidity, poor quality of life, ED emergency department visits, and hospital admissions during 2011 (
) and 2012 (
))
) and 2012 ())Furthermore, high-frequency calling was associated with higher levels of abdominal pain measured by the sub-score of the Short inflammatory bowel disease questionnaire (SIBDQ; question 4), prescription opiate use, and neuropsychiatric comorbidity when compared to those who called less frequently [2, 8, 10, 11] (Fig. 3.1).
High-frequency callers had overall lower quality of life measured by an SIBDQ total score < 50 when compared to the IBD patients who only called 0–1 times a year (Fig. 3.1). Increased telephone encounter frequency was associated with significantly higher health-care utilization as patients who called more than ten times a year had a higher rate of ED visits and hospital admissions (Fig. 3.1) [2, 8, 12–14]. High-frequency callers that were admitted to the hospital displayed more complex and severe symptoms; they showed an overlap of abdominal pain, increased inflammation, and psychiatric comorbidities compared to those who called fewer times .
Similar to more frequent calling, after-hours calling was significantly associated with increased abdominal pain, poor quality of life, elevated CRP, elevated ESR, and higher rates of prednisone use (Fig. 3.2). Furthermore, after-hours callers had higher overall health-care utilization including ED visits, hospital admissions, clinic visits, and increased number of daytime telephone calls (Table 3.1). [9, 15]
Table 3.1
Health-care utilization of patients who called during office hours and after hours
2011 | 2012 | |||||
|---|---|---|---|---|---|---|
Patients who called during regular office hours | Patients who called after hours | P value | Patients who called during regular office hours | Patients who called after hours | P value | |
Clinic visits | 2.39 ± 1.9 | 4.83 ± 3.8 | 0.0001 | 2.55 ± 3.05 | 3.87 ± 4.2 | 0.0001 |
Phone calls during office hours | 4.56 ± 5.3 | 16.93 ± 17.07 | 0.0001 | 4.04 ± 5.5 | 11.8 ± 12.5 | 0.0001 |
ED visits | 0.39 ± 1.4 | 1.49 ± 4.7 | 0.0001 | 0.43 ± 1.6 | 2.19 ± 6.3 | 0.0001 |
Hospital admissions | 0.29 ± 0.8 | 0.98 ± 1.6 | 0.0001 | 0.3 ± 0.97 | 1.22 ± 2.4 | 0.0001 |
Fig. 3.2
Characteristics of after-hours telephone activity 2011–2012. (Patients who called after hours reported more abdominal pain, lower quality of life, higher rates of CRP C-reactive protein and ESR erythrocyte sedimentation rate elevation and increased use of prednisone for both years. *P < 0.05, **P < 0.01, ***P < 0.001)
Telephone Communication in IBD: Opportunities for Intervention
Telephone Call Frequency as a Predictor of Short-Term Health-Care Utilization
The organization of phone calls into clusters showed that increased telephone activity (more than eight phone calls) over 30 days was associated with increased rates of ED use and/or hospitalization over the next 12 months compared to those with only one telephone encounter. Therefore, patients with increased acute telephone activity may serve as a signal to providers of impending deterioration and patients may benefit from an urgent clinic visit and possibly a change in management. [2]
Telephone Calls as a Predictor of Health-Care Charges
In an effort to quantify health-care utilization in a single measure, financial charge data were obtained and categorized for a large group of IBD patients enrolled in the UPMC IBD registry. Charges were categorized by inpatient hospital charges and professional service charges. Hospital charges included fees for room and board, administrative, medication, laboratory, diagnostic testing, and procedures that occurred when admitted to the hospital. Professional service charges included physician or specialized personnel fees for surgery, anesthesia, endoscopy, radiology, pathology, outpatient laboratory testing, outpatient diagnostic tests or procedures (e.g., echocardiogram, bronchoscopy), ED physician services, sex-specific health care (e.g., mammogram, prostate biopsy), and outpatient clinic visits. Finally, a summative total charge category was created by combining the professional service and inpatient related charges. The financial charges were compared to telephone encounter’s frequency. Telephone encounter’s count over 3 years was significantly associated with higher total charges over the same period (Table 3.2). Furthermore, telephone encounters in the first year were predictive of future expenditures over the following year. Therefore, increased telephone encounter frequency is associated with significantly higher health-care spending and is also a significant predictor of future spending. These findings mirror the aforementioned short-term health-care utilization patterns. There was a subgroup of patients who had consistently high telephone activity over the time frame of the study, and these patients accounted for a disproportionate allotment of all health-care charges .
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