The Use of Interactive Voice Response Systems to Improve the Quality and Safety of Ambulatory Care

The Use of Interactive Voice Response Systems to Improve the Quality and Safety of Ambulatory Care

Natalie Oake (Ottawa Health Research Institute, Canada) and Alan J. Foster (Ottawa Health Research Institute and the University of Ottawa, Canada)
DOI: 10.4018/978-1-60566-356-2.ch017
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This chapter highlights how an interactive voice response system (IVRS) may be used to improve quality of care problems associated with ambulatory care. The authors provide examples of quality problems, related to access, effectiveness, and safety, and describe how an IVRS may be used to reduce them. The chapter is also comprised of a comprehensive examination of published literature describing studies that have used IVRS interventions. The majority of these studies used an IVRS to manage patients with chronic disease or change behavior related to preventive medicine. Finally, the authors discuss potential implementation issues, including technological requirements of the IVRS, project management, and scalability of the IVRS.
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There are significant data highlighting various quality problems in the outpatient setting. We will discuss three attributes of care, which we think are particularly important for the overall quality of outpatient care, specifically: access, effectiveness, and safety.

Although access to primary care in many industrialized nations is reasonably good under normal circumstances, there may be problems when patients are unexpectedly ill. Supporting these statements is a recent international survey performed by the Commonwealth Fund (Schoen, 2004). This study found that the vast majority of respondents reported having a regular family doctor. In the Netherlands for instance, almost all people surveyed reported they had a doctor. On the other hand, only 80% of Americans responded similarly. While this may seem like there is acceptable access across populations in different countries, when respondents were asked how long they would wait to be seen by their doctor if they called in sick, 30%-60% stated it would take at least two days to arrange an appointment. There is clearly a gap in quality if patients are unable to be seen by their primary care doctor when they feel they need to be seen.

There is also evidence that effective therapies are frequently not used. For example, McGlyn and colleagues at the Rand Corporation recently performed a systematic analysis to determine compliance with recommended therapies for a number of chronic diseases (McGlynn, 2003). This group established a list of indicated practices for over 200 distinct clinical situations. For example, one recommended practice is to prescribe anti-platelet agents in patients following a myocardial infarction. Using these explicit criteria as a guideline, they then assessed compliance in American ambulatory care patients. They found that recommended therapies were provided in approximately 50% of opportunities. Other investigators have found similar results when evaluating compliance with preventive care such as screening or immunization recommendations.

Key Terms in this Chapter

Ambulatory Care: patient care delivered in outpatient settings (e.g. physician offices).

Interactive Voice Response System: An information technology that facilitates human interactions with databases through a telephone interface.

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