Automated patient surveys allow reliable follow-up

But technology is too new to draw conclusions

Patient feedback is critical in judging the quality of care a health care system delivers. But overall health status, which must be charted over a period of months following discharge, can be an elusive body of information, even as managed care companies place a higher priority on it.

Now there’s a new technology moving into the health care field that holds promise for solving some of the patient follow-up problems hospitals face. It is the automated voice survey. Most of us are familiar with this technology through telephone solicitations and collections. And some health care systems use automated voice products from vendors like Teleminder, in Palo Alto, CA, as schedule reminders or pharmacy drug follow-ups.

So far, only one company, Iameter, in San Mateo, CA, has an automated voice survey system designed to collect the sophisticated data necessary to determine longitudinal health status, although others are sure to appear in the near future. San Antonio Community Hospital in Upland, CA, and Suburban Hospital in Bethesda, MD, are testing Iameter’s system, dubbed I-Vox, to produce timely, periodic patient profiles.

Patient response has been largely positive, says Cathy Hull, director of quality management at San Antonio Community, a 320-bed facility. The hospital is three months into the test, and still fine-tuning its survey questionnaires. Start-up and housekeeping chores are minimal, she says.

Clinical, financial data quickly integrated

This voice survey system allows hospitals to quickly integrate patient health data with clinical and financial data, something that rarely gets done without long delays and a great deal of expense. While health status surveys give a patient-reported picture of physical and emotional health at a given point in time, traditional data collection methods have not been designed to deal with this information, and providers have found it difficult in the past to gather and quantify these patient perspectives.

But that, in a nutshell is what this new technology makes possible. And depending on the volume of surveying done, it could be cost-effective. Iameter charges hospitals around $20,000 in start-up fees and $5 per survey.

The development of this technology follows the emergence of the SF-12 form and reflects the likelihood that patient-centered health information will be required by national accrediting organizations such as the National Committee for Quality Assurance and the Joint Commission on Accreditation of Healthcare Organizations.

The Henry Ford Health System in Detroit signed an agreement this month to use the I-Vox system to administer a 21-question diabetes- specific survey to 1,100 patients. "Henry Ford is using the system because it allows us to proceed in a cost-effective manner," says Reginald F. Baugh, MD, Medical Director of Clinical Resource Improvement Services at Henry Ford Hospital. "At the same time, it helps us to rapidly build information about our patients, to better manage patients and to demonstrate quality."

"We had not been doing specific outcome surveys, at least not as sophisticated as the I-Vox," says Jacque Lobine, RN, clinical efficiency manager at Suburban Hospital. Using the standardized SF-12 surveys, the hospitals collect the initial baseline data early. At San Antonio, it was during check-in at its preoperative center. Suburban administered the surveys at its pre-testing center, where patients enrolled one week prior to surgery. Each patient was handed an educational brochure on I-Vox and told what to expect in the weeks following discharge. This patient education on the system is crucial to obtaining a good response rate.

More than half of patients respond

Patients may decline to participate but both hospitals report that refusals rarely occurred. At key intervals, such as three and six months, discharged patients receive the automated phone call. The questionnaire can be tailored for the specific diagnosis and even personalized with the patient’s name. Iameter makes all the calls from its San Mateo headquarters, and with more than 3,000 surveys completed, the company reports that response rates exceed 50%.

The survey asks 12 questions in either English or Spanish. When completed, the surveys are sent to Iameter, which reviews, catalogs, and tabulates all findings. Once Iameter gets the information, it is filtered into an algorithm that integrates pertinent data on each patient. This may include clinical, financial, emotional, physiological, and satisfaction data, which lay the groundwork for appropriate follow-up surveys.

"We didn’t want to create any additional tasks," says Hull. "My staff’s involvement has been minimal." At Suburban, where the surveys concentrated on cardiology patients, the system frees cardiology staff for more important tasks, says Lobine.

Despite its attractive potential, it is too soon to say whether automated voice surveying will become a standard tool in a hospital’s data- gathering tool chest. Only after more systems come on the market and the health care industry gains experience with the technology, will true comparisons with traditional mail or phone survey techniques be possible.

[Editor’s note: For more information, contact Cathy Hull, San Antonio Community Hospital, (909) 985-2811; Jacque Lobine, Suburban Hospital, (301) 896-3100; or Reginald F. Baugh, Henry Ford Hospital, (313) 876-2600.]