Melzer S M, Poole S R
Department of Pediatrics, Children's Health Care System, University of Washington School of Medicine, Seattle, USA.
Arch Pediatr Adolesc Med. 1999 Aug;153(8):858-63. doi: 10.1001/archpedi.153.8.858.
To describe the operating characteristics, financial performance, and perceived value of computerized children's hospital-based telephone triage and advice (TTA) programs.
A written survey of all 32 children's hospital-based TTA programs in the United States that used the same proprietary pediatric TTA software product for at least 6 months.
The expense, revenues, and perceived value of children's hospital-based TTA programs.
Of 30 programs (94%) responding, 27 (90%) were eligible for the study and reported on their experience with nearly 1.3 million TTA calls over a 12-month period. Programs provided pediatric TTA services for 1560 physicians, serving an average of 82 physicians (range, 10-340 physicians) and answering 38880 calls (range, 8500-140000 calls) annually. The mean call duration was 11.3 minutes and the estimated mean total expense per call was $12.45. Of programs charging fees for TTA services, 16 (59%) used a per-call fee and 7 (26%) used a monthly service fee. All respondents indicated that fees did not cover all associated costs. Telephone triage and advice programs, when examined on a stand-alone basis, were all operating with annual deficits (mean, $447000; median, $325000; range, $74000-$1.3 million), supported by the sponsoring children's hospitals and their companion programs. Using a 3-point Likert scale, the TTA program managers rated the value of the TTA program very highly as a mechanism for marketing to physicians (2.85) and increasing physician (2.92) and patient (2.80) satisfaction.
Children's hospital-based TTA programs operate at substantial financial deficits. Ongoing support of these programs may derive from the perception that they are a valuable mechanism for marketing and increase patient and physician satisfaction. Children's hospitals should develop strategies to ensure the long-term financial viability of TTA programs or they may have to discontinue these services.
描述基于儿童医院的计算机化电话分诊与咨询（TTA）项目的运营特点、财务表现及感知价值。
对美国所有32个基于儿童医院的TTA项目进行书面调查，这些项目使用同一专利儿科TTA软件产品至少6个月。
基于儿童医院的TTA项目的费用、收入及感知价值。
30个项目（94%）做出回应，其中27个（90%）符合研究条件，并报告了其在12个月期间处理近130万通TTA电话的经验。各项目为1560名医生提供儿科TTA服务，平均服务82名医生（范围为10 - 340名医生），每年接听38880通电话（范围为8500 - 140000通电话）。平均通话时长为11.3分钟，估计每通电话的平均总费用为12.45美元。在收取TTA服务费用的项目中，16个（59%）采用每次通话收费，7个（26%）采用每月服务费。所有受访者表示费用无法覆盖所有相关成本。单独来看，电话分诊与咨询项目均处于年度亏损运营状态（平均亏损447000美元；中位数为325000美元；范围为74000 - 130万美元），由主办儿童医院及其附属项目提供支持。使用3点李克特量表，TTA项目经理对TTA项目作为向医生营销的机制以及提高医生（2.92）和患者（2.80）满意度的价值给予了高度评价（2.85）。
基于儿童医院的TTA项目存在大量财务亏损。对这些项目的持续支持可能源于它们被视为一种有价值的营销机制以及能提高患者和医生满意度的认知。儿童医院应制定策略以确保TTA项目的长期财务可行性，否则可能不得不停止这些服务。
