Telenurse Service in a Military Managed Care Setting

With military treatment facilities facing capitated budgets under managed care systems, hospital commanders are responsible for delivering health care on a fixed-price, shared-risk basis. To preserve health care resources, managed care Organizations support programs that encourage healthy behaviors and decrease consumer demand for unnecessary medical services. To that end, in March 1999, William Beaumont Army Medical Center (WBAMC) instituted a telephone nursing advice system using standardized triage protocols from the Centramax M. Plus software. Although nurses have used telephone technology in their practices for many years, nurse-run advice lines in managed health care settings are relatively new. Few studies have evaluated such programs in terms of their impact on managed care goals to reduce demand for medical services and increase disease-preventing behaviors.

The goal of this study is to evaluate the nurse telephone triage (TAN) line at William Beaumont Army Medical Center (WBAMC). The objectives are to evaluate 1) patient usage of the service; 2) its impact on WBAMC medical services; 3) patient health-seeking and disease prevention behavior; and, 4) patient satisfaction with the service. The "Tel-a-nurse" advice line has the potential to make a tremendous contribution to military health care. Evaluative data will be critical to future decisions about not only incorporating the TAN service into a comprehensive healthcare package at WBAMC but potentially at other military medical treatment facilities as well.