Factors Associated With the Resolution of Telephone Follow-up in Palliative Home Care Patients of a Public Telemedicine Service: A Retrospective Observational Study Using Machine Learning

Introduction The use of telemedicine in palliative care has become an effective tool. Telephone follow-up allows for the anticipation of complications, the resolution of doubts, and the provision of peace of mind. However, case resolution is conditioned by various factors. Objective The objective of this study was to analyze the factors influencing the resolution of nurse-led telephone follow-ups of palliative home care patients treated by nurses at the Salud Responde public telemedicine service in Andalusia (Spain). Methods A retrospective observational study was conducted that included 44,981 records of requests from palliative home care patients who were treated by nurses at the Salud Responde public telemedicine service during the period between 2012 and 2024. It is important to note the distinction between two profiles: proactive palliative patients, characterised by clinical stability and proactive management of complications through planned follow-up; and reactive palliative patients, who are more clinically complex and initiate contact with the service on an unscheduled basis. The study variables are grouped into the following blocks: sociodemographic data, temporal data and clinical data on the patient, reflecting the type of resolution of each consultation. Machine learning techniques were applied, using the Random Forest model to predict the type of resolution of each call, which differentiated between health advice and referral to other levels of care. Results Of the records included, 74.44% corresponded to proactive patients and 25.56% to reactive patients. The model established a set of rules that achieved high accuracy in proactive patients (96.5%), but low accuracy in reactive ones (41.2%). In proactive patients, healthcare advice stands out as the resolution of cases, while the factors most associated with resolution were clinical status, age, respiratory distress and conspiracy of silence. Conclusion The resolution of demands raised by palliative home care patients through telephone follow-up is conditioned by various factors. This study describes the criteria that mainly affect the profile of the proactive patient. These findings are relevant for implementing improvements in decision-making and in the organisation of telemedicine, ensuring continuity and quality care.