title: Listening to the nurse pays off: an integrated Nurse HealthLine programme was associated with significant cost savings.
abstract: OBJECTIVE
  To estimate the relationship between adherence to nurse recommendations about where to seek care and expenditures for health-care services received by callers to a Nurse HealthLine telephone-based triage programme.
  
  
  METHODS
  Health-care utilization and claims data from callers to the Nurse HealthLine were included. Adherent callers were those who followed the nurse recommendations, while those who did not were classified as non-adherent. Programme-related savings were estimated using differences in downstream health-care expenditures between adherent and non-adherent callers after using multivariate modelling to adjust for between-group differences.
  
  
  RESULTS
  Fifty-five per cent of callers were adherent. Nurses were over three times as likely (41% vs. 13%) to recommend seeking a higher level of care (e.g. emergency room vs. urgent care). Regression analyses showed that the impact of getting members to the appropriate place of care was associated with significant annual savings of $13.8 million (P < 0.05), attributable mostly to Medicare, generating a positive return on investment of $1.59.
  
  
  CONCLUSIONS
  This is the first known Nurse HealthLine triage programme exclusively for Medicare beneficiaries with supplemental coverage.
  
  
  CONCLUSIONS
  Nurse managers should consider promoting telephone-based triage programmes as complementary to clinical nursing, which has a direct impact on health-care utilization and costs.
authors.affiliation: OptumHealth, Golden Valley, MN, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Navratil-Strawn
authors.forename: Kevin
authors.initials: K
authors.lastname: Hawkins
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Wells
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Ozminkowski
authors.forename: Jean
authors.initials: J
authors.lastname: Hawkins-Koch
authors.forename: Hungching
authors.initials: H
authors.lastname: Chan
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Hartley
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Migliori
authors.forename: Charlotte S
authors.initials: CS
authors.lastname: Yeh
mesh_terms: D003142:Communication; D017046:Cost Savings / Q000379:methods*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D009723:Nurse-Patient Relations; D015403:Nursing Evaluation Research; D010349:Patient Compliance / Q000706:statistics & numerical data*; D019114:Remote Consultation / Q000191:economics* / Q000379:methods; D013689:Telephone / Q000706:statistics & numerical data*; D014218:Triage / Q000191:economics / Q000379:methods* / Q000592:standards
keywords: Medicare; economics; nurse; telephone hotline