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Modeling the effects of telephone nursing on healthcare utilization
Luleå University of Technology, Department of Engineering Sciences and Mathematics, Mathematical Science.ORCID iD: 0000-0002-6289-4949
Luleå University of Technology, Department of Health Sciences, Nursing Care.ORCID iD: 0000-0001-8990-752X
2018 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 113, p. 98-105Article in journal (Refereed) Published
Abstract [en]

Background

Telephone nursing is the first line of contact for many care-seekers and aims at optimizing the performance of the healthcare system by supporting and guiding patients to the correct level of care and reduce the amount of unscheduled visits. Good statistical models that describe the effects of telephone nursing are important in order to study its impact on healthcare resources and evaluate changes in telephone nursing procedures

Objective

To develop a valid model that captures the complex relationships between the nurse's recommendations, the patients’ intended actions and the patients’ health seeking behavior. Using the model to estimate the effects of telephone nursing on patient behavior, healthcare utilization, and infer potential cost savings.

Methods

Bayesian ordinal regression modelling of data from randomly selected patients that received telephone nursing. Inference is based on Markov Chain Monte Carlo (MCMC) methods, model selection using the Watanabe-Akaike Information Criteria (WAIC), and model validation using posterior predictive checks on standard discrepancy measures.

Results and Conclusions

We present a robust Bayesian ordinal regression model that predicts three-quarters of the patients’ healthcare utilization after telephone nursing and we found no evidence of model deficiencies. A patient's compliance to the nurse's recommendation varies and depends on the recommended level of care, its agreement with and level of the patient's prior intention, and the availability of different care options at the time. The model reveals a risk reducing behavior among patients and the effect of the telephone nursing recommendation is 7 times higher than the effect of the patient's intended action prior to consultation if the recommendation is the highest level of care. But the effect of the nurse's recommendation is lower, or even non-existing, if the recommendation is self-care. Telephone nursing was found to have a constricting effect on healthcare utilization, however, the compliance to nurse's recommendation is closely tied to perceptions of risk, emphasizing the importance to address caller's needs of reassurance

Place, publisher, year, edition, pages
Elsevier, 2018. Vol. 113, p. 98-105
National Category
Probability Theory and Statistics Nursing
Research subject
Mathematical Statistics; Nursing
Identifiers
URN: urn:nbn:se:ltu:diva-67611DOI: 10.1016/j.ijmedinf.2018.02.004ISI: 000431199300013PubMedID: 29976474Scopus ID: 2-s2.0-85043290149OAI: oai:DiVA.org:ltu-67611DiVA, id: diva2:1182066
Note

Validerad;2018;Nivå 2;2018-03-15 (andbra)

Available from: 2018-02-12 Created: 2018-02-12 Last updated: 2018-08-08Bibliographically approved

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