Original Article
Telephone follow-up was more expensive but more efficient than postal in a national stroke registry

https://doi.org/10.1016/j.jclinepi.2013.03.005Get rights and content

Abstract

Objective

To compare the efficiency and differential costs of telephone- vs. mail-based assessments of outcome in patients registered in a national clinical quality of care registry, the Australian Stroke Clinical Registry (AuSCR).

Study Design and Setting

The participants admitted to hospital with stroke or transient ischemic attack were randomly assigned to complete a health questionnaire by mail or telephone interview at 3–6 months postevent. Response rate, researcher burden, and costs of each method were compared.

Results

Compared with the participants in the mail questionnaire arm (n = 277; 50% female; mean age: 70 years), those in the telephone arm (n = 282; 45% female; mean age: 68 years) required a shorter time to complete the follow-up (mean difference: 24.2 days; 95% confidence interval [CI]: 15.0, 33.5 days). However, the average cost of completing a telephone follow-up was greater (US$20.87 vs. US$13.86) and had a similar overall response to the mail method (absolute difference: 0.57%; 95% CI: −4.8%, 6%).

Conclusion

Posthospital stroke outcome data were slower to collect by mail, but the method achieved a similar completion rate and was significantly cheaper to conduct than follow-up telephone interview. Findings are informative for planning outcome data collection in large numbers of patients with acute stroke.

Section snippets

Costs and efficiency of patient follow-up in the Australian Stroke Clinical Registry: randomized comparison of telephone vs. postal methods

Registries provide the gold-standard method of capturing critical data necessary for assessing variations in practice and care because they encapsulate patient populations with a broad range of characteristics in “real-world” conditions [1]. They also provide an opportunity to assess the uptake of proven treatments [2], [3] and use of hazardous or expensive aspects of health care [4], [5]. Although the patterns of presentation, clinical profile, acute management, and effects of treatment in

Participants

All patients with acute stroke or TIA who were admitted to participating hospitals are identified for inclusion in a national registry, the AuSCR. Stroke or TIA are defined using International Classification of Diseases (ICD-10) codes: I63 Cerebral Infarction (I63.0, I63.1, I63.2, I63.3, I63.4, I63.5, I63.6, I63.8, and I63.9); I64 Stroke, not specified as hemorrhage or infarction; I61 intracerebral hemorrhage (I61.0−I61.9); I62 other nontraumatic intracerebral hemorrhage (I62.0, I62.1, and

Results

Table 1 shows that there were no major differences in the baseline characteristics or outcomes of respondents between the randomized follow-up arms. Fig. 1 outlines the flow of patients through the study. There were statistically significant differences between the proportion of respondents who switched from mail to telephone method owing to lack of response (19/282) and from telephone to mail method (50/277; P = 0.0001).

The overall combined primary response rate was 392 of 559 (70.1%). A

Discussion

This study showed that telephone data collection with postal reminder, and postal data collection with telephone reminder, were both effective strategies for collecting medium-term outcome data from participants in a large-scale prospective stroke registry. Although the finding of equivalent response rates for the telephone and postal administration is consistent with previous studies of survey completion [16], this has been demonstrated for the first time specifically within a voluntary,

Acknowledgment

During this study period, the Australian Stroke Clinical Registry was supported by the Australian Commission for Safety and Quality in Health Care (tender 018/0809) and an unrestricted educational grant provided by Allergan Australia.

References (20)

There are more references available in the full text version of this article.

Cited by (27)

  • Understanding of medications and associations with adherence, unmet needs, and perceived control of risk factors at two years post-stroke

    2022, Research in Social and Administrative Pharmacy
    Citation Excerpt :

    Follow-up was conducted by staff from the AuSCR office who had access to patient identifiable information. To maximize the response rate, a modified Dillman protocol was used similar to routine AuSCR follow-up between 90 and 180 days.13,14 This involved a second mail-out attempt if no response was received from the first, and a further attempt by telephone for a portion of non-responders if both earlier mail attempts were unsuccessful.14

  • Adding Centralized Electronic Patient-Reported Outcome Data Collection to an Established International Clinical Outcomes Registry

    2022, Transplantation and Cellular Therapy
    Citation Excerpt :

    We intend to explore the impact of providing a postage-paid mail-in option on response rates. Future studies could explore other strategies, such as telephone-assisted collection [26], for increasing response to routine PRO collection and reengaging patients who implicitly refuse. A common barrier to enrollment reported from other cancer registries collecting PROs is differences by sex and socioeconomic status in responders compared with nonresponders [23].

  • The Quality of Discharge Care Planning in Acute Stroke Care: Influencing Factors and Association with Postdischarge Outcomes

    2018, Journal of Stroke and Cerebrovascular Diseases
    Citation Excerpt :

    To maintain anonymity, an AuSCR staff member distributed the survey to consecutive, eligible participants. A 2-phase mail out process was used to maximize the response rate.13 The AuSCR office staff recorded each participant's survey ID number against their AuSCR ID number so that the questionnaire data could be anonymously linked to the AuSCR data.

View all citing articles on Scopus
View full text