Cheng Anthony, Hart Kyle, Baron Andrea, Dollar Emily, Park Brian, DeVoe Jen, Herman Eric, Johnson Julie, Cohen Deborah J
Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA.
BMC Nurs. 2024 Sep 5;23(1):622. doi: 10.1186/s12912-024-02270-8.
The Covid Connected Care Center (C4), a low-barrier telephone nurse hotline, was developed at an academic medical center to increase access to healthcare information and services across the state of Oregon, including to those without a usual source of care. Other studies have demonstrated that telephone triage services can positively influence health behaviors, but it is not known how this effect is maintained across racial/ethnic groups. The objective of this study was to show that the C4 reached throughout the state of Oregon, was valuable to callers, and that recommendations given affected callers' subsequent health-related behaviors.
This mixed-methods study, informed by the RE-AIM (Reach, Effectiveness, Addoption, Implementation and Maintenance) framework, assessed caller demographics and clinical care from March 30 2020 until September 8, 2021. Descriptive statistics, multivariable risk models and Zou's modified Poisson modeling were applied to electronic health record and call system data; An inductive approach was used for patient and staff experience surveys and semi-structured interviews. Approval was obtained from the OHSU Institutional Review Board (Study 00021413).
145,537 telephone calls and 92,100 text-based contacts (61% and 39%, respectively) were included. Callers tended to not have a usual source of primary care and utilized recommended services. Emergency department utilization was minimal (1.5%). Racial or ethnic disparities were not detected in the recommendations, but Black (RR 0.92, CI 0.86-0.98) and Multiracial (RR 0.90 CI 0.81-0.99) callers were less likely than non-Hispanic white callers to receive a COVID-19 test. Participants in the post-call survey (n = 50) would recommend this service to friends or family. Interviews with callers (n = 9) revealed this was because they valued assistance translating general recommendations into a personalized care plan. C4 staff interviewed (n = 9) valued the opportunity to serve the public. The C4 was a trusted resource to the public and reached the intended audiences. However, disparities in access to COVID-19 testing persisted.
Nursing triage hotlines can guide caller behavior and be an effective part of a robust public health information infrastructure.
新冠关联护理中心（C4）是一家学术医疗中心设立的低门槛电话护士热线，旨在增加俄勒冈州民众获取医疗保健信息和服务的机会，包括那些没有固定医疗服务来源的人群。其他研究表明，电话分诊服务可以对健康行为产生积极影响，但尚不清楚这种影响在不同种族/族裔群体中是如何维持的。本研究的目的是表明，C4覆盖了俄勒冈全州，对来电者有价值，且给出的建议会影响来电者随后的健康相关行为。
这项混合方法研究以RE-AIM（覆盖范围、有效性、采用情况、实施情况和维持情况）框架为指导，评估了2020年3月30日至2021年9月8日期间来电者的人口统计学特征和临床护理情况。将描述性统计、多变量风险模型和邹氏修正泊松模型应用于电子健康记录和呼叫系统数据；采用归纳法进行患者和工作人员体验调查及半结构化访谈。获得了俄勒冈健康与科学大学机构审查委员会的批准（研究编号00021413）。
共纳入145,537个电话呼叫和92,100个基于文本的联系（分别占61%和39%）。来电者往往没有固定的初级保健服务来源，并利用了推荐的服务。急诊室利用率很低（1.5%）。在建议方面未发现种族或族裔差异，但黑人（相对风险0.92，置信区间0.86 - 0.98）和多种族（相对风险0.90，置信区间0.81 - 0.99）来电者比非西班牙裔白人来电者接受新冠病毒检测的可能性更小。呼叫后调查的参与者（n = 50）会向朋友或家人推荐这项服务。对来电者的访谈（n = 9）显示，这是因为他们重视将一般建议转化为个性化护理计划的帮助。对C4工作人员的访谈（n = 个）重视服务公众的机会。C4是公众信赖的资源，覆盖了目标受众。然而，在获取新冠病毒检测方面的差异仍然存在。
护理分诊热线可以指导来电者的行为，成为强大的公共卫生信息基础设施的有效组成部分。
