Web Triage as a Critical Patient Portal Function: RCT for Safety and Cost-Savings

DESCRIPTION (provided by applicant): Studies of patient triage in selected populations found significant numbers of patients needing either a more or a less acute level of care, and that 47%-58% of ED visits were considered inappropriate by triage nurses and physicians. Contributing to this problem is lack of accessibility and responsiveness of services to determine the appropriate level of care. In one study, 62% of patients could not reach their primary care physician before going to the ER. Telephone triage has been proposed as one solution, but lack of reimbursement and the high cost of nurse time have prevented telephone triage from widespread implementation. Web triage systems use the same protocols as telephone triage, but patients can answer the questions over the web and receive recommendations through a web-based Clinical Decision Support (CDS) system, greatly reducing costs. Though existing research on web triage systems have shown promise, including good congruence with nurse recommendations and high patient satisfaction, there is a need to measure the safety and cost-savings of this approach before it can be widely deployed. A retrospective analysis of 1,500 patient records in partnership with Campus Health Services (CHS) at the University of North Carolina at Chapel Hill has found the potential to save $300,000 per year. The goals of the proposed project are to implement, test, and verify safety and cost-savings, of a web-based CDS triage system. Innovative, new features to improve safety and cost savings, including integration with electronic medical records, the Patient Portal, and the triage nurse's workflow, and include comprehensive quality management techniques, will be added to the current system. A randomized controlled trial with CHS measuring safety and cost savings of web triage versus current practice will be conducted. The savings accrued with the proposed system could be returned to students through reduced fees or other services. Successful achievement of this project could lead to a CDS system with large commercial potential -- saving millions of dollars for insurance companies, and providing improved patient safety, more appropriate care, and lower costs for consumers. PUBLIC HEALTH RELEVANCE: Our web triage system uses Clinical Decision Support (CDS) to recommend patients an appropriate level of care, urgency, and even articles on self-care options over the web. This system has the potential to make significant improvements to the delivery and management of primary and emergency care, including improved responsiveness, patient safety, identifying lower cost care alternatives, and reducing insurance premiums for consumers. We plan to run a randomized controlled trial (RCT) to better understand the safety and cost savings of web triage, which remain as two barriers to adoption of this technology in the general community.