CASE STUDY Reach Out to Patients for Better Disease Management Logansport Memorial Hospital How automated reminders led to a higher compliance rate for overdue labs by diabetic patients.
Quick Summary Logansport Memorial Hospital is a not-for-profit, county-owned, regional medical center serving people in Cass County and north central Indiana. They have an 83-bed acute care facility, with an ambulatory surgery center, full outpatient services, a Level II emergency room and three off-campus clinics. LMH s medical staff is comprised of 90 active and consulting physicians and nurse practitioners. To better engage and increase compliance by their diabetic patients for overdue periodic lab, Logansport Memorial Hospital activated the Hemoglobin A1C Lab Reminder Campaign. The Campaign was designed to automate sending a notification to diabetic patients without a completed hemoglobin A1c lab within the past year. From within the message, patients had the option to respond and reply whether they had the lab ordered with another provider. The responses flowed into the Analytics dashboard for staff to review and take the appropriate action. The purpose of this study was to investigate the impact the Hemoglobin A1C Lab Reminder Campaign had in engaging non-compliant diabetics to either update the practice of a completed lab via a response or to come in for their test. To accomplish the analysis, patient data and encounter data was analyzed for those who were contacted by the Messenger Campaign. The overall analysis has shown that the automated Messenger Campaign prompted a significant response from those contacted and proved to be impactful in improving care to patients with chronic conditions such as diabetes.
The Problem For patients with chronic conditions such as diabetes, comprehensive and timely care is imperative for proper disease management. Timely visits and lab work is needed to monitor the effectiveness of the current treatment plan. For diabetic patients, the hemoglobin A1C lab is an integral component of their disease management program. The A1C test is a blood test that provides information about a person s average levels of blood glucose, also called blood sugar, over the past 3 months. The A1C test is the primary test used for diabetes management and diabetes research 1. Figure 1 displays the frequency of testing recommended by the American Diabetes Association. Though the importance of the hemoglobin test cannot be understated, diabetics often miss or fail to come in for this lab. The fact that one in seven patients did not complete lab work within six months of the provider referral may help explain why healthcare services appear to fall short of optimal diabetes care 2. According to a recent study published by the American Journal of Managed Care -Population Health Approach for Diabetic Patients With Poor A1C Control providers should proactively reach out to their entire population between office visits so that patients waiting too long to get retested are motivated to have that testing done earlier 3. However, from the practice perspective, to contact non-compliant patients manually is resource intensive and costly. For example, sending postcards/snail mail is costly and there is no way to track its effectiveness. Further manual outreach requires resources to run reports, filter patients, stuff envelopes, etc. For most practices, this is not cost or workflow efficient. This task is not automated and it is the responsibility of staff to remember when to contact the patients. 1 http://1.usa.gov/1l0aidf 2 http://1.usa.gov/1m46ucr 3 http://bit.ly/1iwkjot 4 http://bit.ly/1m454bv
The Solution Messenger is the automated patient communication tool within the patient-centric suite of solutions offered by. The notifications generated by Messenger can be used for a variety of purposes, for everything from appointment reminders to preventative service notifications via the Campaigns feature. By automating the outreach, Campaigns effectively resolve the challenges of contacting patients and address the workflow and resource concerns. To meet the challenges of contacting diabetics without a completed hemoglobin A1C lab, Logansport Memorial Hospital activated the Hemoglobin A1C Lab Messenger Campaign. This Campaign was designed to contact diabetic patients without a hemoglobin A1C result on their record within the past year. The patients were automatically selected based on this criteria and received voice, text, patient portal, or app messages, depending on their preferences. The message content allowed the patient to indicate whether they had the test performed elsewhere. The responses from the patient were visible to the practice from within the Campaign Dashboard. The automated nature of the Campaign addressed the cost and workflow issues in comparison to a manual outreach effort, proving to be both effective and efficient in prompting diabetic patients to complete their necessary lab work.
Reach Non-Compliant Patients Targeted outreach to patients Logansport Memorial Hospital chose to send the Hemoglobin A1C Reminder Campaign using multiple methods of patient contact to expand their outreach capability. Total Messages Sent (Multi-Modality Outreach) 3174 Total Patients Contacted Using the Campaign 1230 Total Unique Patients Contacted Using Voice 1154 Total Unique Patients Contacted Using Patient Portal 626 Gender of Unique Patients 51% 49% Age of Contacted Patients 1% 18-28 yrs 3% 28-38 yrs 13% 38-48 yrs 25% 48-58 yrs 35% 58-68 yrs 23% 68-78 yrs Data for the Campaign delivery was analyzed from April 2015-July 2015
Response from the Patient Population 51% Patient Response 51% of patients responded by either following the prompt from the 47% Voice Response More than 47% of patients responded to the voice modality message and 16% to the portal outreach. message or calling and scheduling the test. W 16% Portal Response 21% of Patients Responded YES Females were more responsive than males in completing the lab order. 21% of patients responded YES that they had the test done elsewhere. The Campaign helped close the loop 57% of communication between the provider and patient. 43%
Outcomes and Practice Impact The Campaign prompted patients to come in and complete their overdue hemoglobin A1C labs. The analysis of the Campaign response showed that 41% of patients had A1C levels above the recommended value of seven. The Campaign messages prompted the patients to complete the lab order and as a result enabled Logansport Memorial Hospital to provide timely care to those whose blood glucose levels were above the normal thresholds. The timely outreach provided an opportunity to engage non-compliant patients, improved their care, and helped providers make the necessary changes to their treatment plan. As a result of the Campaign, Logansport Memorial Hospital was able to find these patients and appropriately manage their care. Hemoglobin A1C Attribute Results 59% of patients had values below 7 41% of patients had values above 7 Values indicated above are only for patients whose test results were received electronically. Patient Story from Logansport: We recently had a patient with type 2 diabetes who had not had an A1C test done in over a year. After receiving the Hemoglobin A1C reminder call, the patient came in for an appointment, had the test done, and we discovered that their A1C was elevated to 14.9. We were able to act on this information and referred the patient to a diabetic educator to have medication started along with changes to diet and exercise. Campaigns have enabled a number of our diabetic patients to be more compliant with their own healthcare. They are helping us to reach our patients to provide comprehensive quality care. David Schmidt Logansport Memorial Hospital
Conclusion Using the automated technology of the Messenger Hemoglobin A1C Reminder Campaign, Logansport Memorial Hospital was able to engage their diabetic patients to complete essential lab work. The multiple methods of contact used for the Campaign outreach made an impact in reaching the pertinent patient population. Patients reacted positively to the health maintenance reminder and over 50% responded. The Campaign outreach played a part in notifying patients about their overdue test and improved compliance from non-responsive patients. Automated systems such as Messenger Campaigns are effective tools to reach and prompt patients to take charge of their own healthcare. For more information, please contact messenger@eclinicalworks.com The case study was prepared by: Sidd Shah, Shaheel Dholakia, Merlin Mathew and Akbar Shah.