Disparities in the Timeliness of Addressing Patient-Initiated Telephone Calls in a Primary Care Clinic: The Impact of Quality Improvement Interventions

ABSTRACT

A timely response to patient-initiated telephone calls can affect many aspects of patient health, including quality of care and health equity. Historically, at a family medicine residency clinic, at least 1 out of 4 patient calls remained unresolved three days after the call was placed. We sought to explore whether there were differential delays in resolution of patient concerns for certain groups and how these were affected by quality improvement interventions to increase responsiveness to patient calls. A multidisciplinary team at a primary care residency clinic applied Lean education and tools to improve the timeliness of addressing telephone encounters. Telephone encounter data were obtained for one year before and nine months after the intervention. Data were stratified by race, ethnicity, preferred language, sex, online portal activation status, age category, zip code, patient risk category, and reason for call. Stratified data revealed consistently worse performance on telephone encounter closure by 72 hours for Black/African American patients compared to Hispanic and non-Hispanic White patients pre-intervention. Interventions resulted in statistically significant overall improvement, with an OR of 2.9 (95% CI: 2.62 to 3.21). Though interventions did not target a specific population, pre-intervention differences based on race and ethnicity resolved post-intervention. Telephone calls serve as an important means of patient communication with care teams. General interventions to improve the timeliness of addressing telephone encounters can lead to sustainable improvement in a primary care academic clinic and may also alleviate disparities.

Acknowledgement

Many thanks to the members of the Island East Clinic team for the dedication and commitment to improvement that made this work possible. Dr. Jeff Susman, Dr. Wei-Chen Lee, and Dr. Charlotte Noble provided invaluable support, ideas, and advice. Christen Walcher assisted with manuscript preparation. We are grateful to the “Lean Team” and to the UTMB and departmental leadership who supported and guided us in the improvement work, including Pete Gutierrez, Raj Menon, Dr. Tim Harlin, Jenny Lanier, Dr. Barbara Thompson, and Dr. Kendall Campbell.

Disclosure statement

No potential conflict of interest was reported by the author(s).

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Funding

The author(s) reported there is no funding associated with the work featured in this article.