title: Improving the quality of telephone-delivered health care: a national quality improvement transformation initiative.
abstract: BACKGROUND
  Many Veterans Affairs (VA) primary care (PC) patients prefer telephone-delivered care to other health care delivery modalities.
  
  
  OBJECTIVE
  To evaluate PC patients' telephone experiences and outcomes before and after a national telephone transformation quality improvement (QI) collaborative.
  
  
  METHODS
  Cross-sectional surveys were conducted pre- and post-collaborative. We used bivariate analyses to assess differences in pre/post outcomes and multivariate regression to identify variables associated with patients' perceptions of poor quality care.
  
  
  RESULTS
  Patients from 13 VA facilities participated (n = 730; pre-intervention = 314, post-intervention = 416); most of them were males (90%) with a mean age of 62 years. After the collaborative (versus pre-collaborative), few experienced transfers (52% versus 62%, P = 0.0006) and most reported timely call answer (88% versus 80%, P = 0.003). Improvements in staff understanding why patients were calling and providing needed medical information were also found. There were measurable improvements in patient satisfaction (87% versus 82% very/mostly satisfied, P = 0.04) and perceived quality of telephone care (85% versus 78% excellent/good quality, P = 0.01) post- collaborative. The proportion of veterans who reported delayed care due to telephone access issues decreased from 41% to 15% after the collaborative, P < 0.0001. Perceptions of poor quality care were higher when calls were for urgent care needs did not result in receipt of needed information and included a transfer or untimely answer.
  
  
  CONCLUSIONS
  The QI collaborative led to improvements in timeliness of answering calls, patient satisfaction and perceptions of high-quality telephone care and fewer reports of health care delays. Barriers to optimal telephone care 'quality' include untimely answer, transfers, non-receipt of needed information and urgent care needs.
authors.affiliation: Department of Veterans Affairs, Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Hines, IL.
authors.forename: Sherri L
authors.initials: SL
authors.lastname: LaVela
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gering
authors.forename: Gordon
authors.initials: G
authors.lastname: Schectman
authors.forename: Sara M
authors.initials: SM
authors.lastname: Locatelli
authors.forename: Frances M
authors.initials: FM
authors.lastname: Weaver
authors.forename: Michael
authors.initials: M
authors.lastname: Davies
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D058996:Quality Improvement; D013689:Telephone; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: Health communication; health care delivery; patient preference; patient-centred care; primary health care; quality improvement