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AlQassab O, Kanthajan T, Pandey M, Francis AJ, Sreenivasan C, Parikh A, Nwosu M. Evaluating the Impact of Telemedicine on Diabetes Management in Rural Communities: A Systematic Review. Cureus 2024; 16:e64928. [PMID: 39035595 PMCID: PMC11260063 DOI: 10.7759/cureus.64928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 07/19/2024] [Indexed: 07/23/2024] Open
Abstract
Telemedicine is the delivery of healthcare services using information and communication technologies to diagnose, treat, and prevent diseases. The COVID-19 pandemic has accelerated the adoption of telemedicine, transforming how healthcare is delivered, especially in remote and underserved areas. Despite its potential, no systematic reviews have been conducted in the last five years to assess the effectiveness of telemedicine for managing diabetes in rural populations. This review addresses this gap by evaluating studies on telemedicine's impact on glycemic control among diabetic patients in these settings. We searched five databases: PubMed, Google Scholar, ClinicalTrials.gov, ScienceDirect, and Science.gov, covering studies published in the last five years. Of the 331 articles identified, 10 met our inclusion criteria: English-language studies from the past five years involving adults in rural areas or comparing rural and urban settings, focusing on telemedicine's impact on glycemic control in diabetic patients. In many studies, the findings revealed that telemedicine interventions integrated into structured programs significantly improved HbA1c levels. Successful implementation requires local infrastructure and consistent patient-provider interactions, although increased healthcare provider workloads may affect sustainability. Telemedicine alone was less effective for patients with complex comorbidities, suggesting that a combined approach with in-person visits may be more effective. This review highlights telemedicine's potential to replace routine in-person visits for diabetes management in rural areas, demonstrating significant improvements in HbA1c levels, medication adherence, and timely care management support. Future research should focus on randomized controlled trials in rural settings, hybrid care models that optimize in-person visit frequency and remote monitoring, and addressing technological challenges such as broadband access and platform usability to ensure sustainable telehealth interventions.
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Affiliation(s)
- Osamah AlQassab
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Tatchaya Kanthajan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Manorama Pandey
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aida J Francis
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Chithra Sreenivasan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aneri Parikh
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Marcellina Nwosu
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Jaske E, Wheat CL, Rubenstein LV, Leung L, Curtis I, Wahlberg L, Felker B. Understanding How Contingency Staffing Programs Can Support Mental Health Services in the Veterans Health Administration. Telemed J E Health 2024; 30:1857-1865. [PMID: 38563753 DOI: 10.1089/tmj.2023.0573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Introduction: Beginning in 2019, the Department of Veterans Affairs (VA) prioritized improving access to care nationally to deliver virtual care and implemented 18 regionally based Clinical Resource Hubs (CRHs) to meet this priority. This observational study describes the quantity and types of care delivered by CRH Mental Health teams, and the professions of those hired to deliver it. Methods: A retrospective cohort study, based on national VA CRH mental health care utilization data and CRH staffing data for CRH's first 3 years, was conducted. Results: CRH Mental Health teams primarily used Telemental Health (TMH) to provide care (98.1% of all CRH MH encounters). The most common disorders treated included depression, post-traumatic stress disorder, and anxiety disorders. The amount of care delivered overtime steadily increased as did the racial and ethnic diversity of Veterans served. Psychologists accounted for the largest share of CRH staffing, followed by psychiatrists. Conclusions: CRH TMH delivered from a regional hub appears to be a feasible and acceptable visit modality, based on the continuously increasing CRH TMH visit rates. Our results showed that CRH TMH was predominantly used to address common mental health diagnoses, rather than serious mental illnesses. Traditionally marginalized patient populations increased over the 3-year window, suggesting that CRH TMH resources were accessible to many of these patients. Future research should assess barriers and facilitators for accessing CRH TMH, especially for difficult-to-service patient populations, and should consider whether similar results to ours occur when regional TMH is delivered to non-VA patient populations.
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Affiliation(s)
- Erin Jaske
- VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington, USA
- Primary Care Analytics Team, Department of Veterans Affairs, Seattle, Washington, USA
| | - Chelle L Wheat
- VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington, USA
- Primary Care Analytics Team, Department of Veterans Affairs, Seattle, Washington, USA
| | - Lisa V Rubenstein
- Center for the Study of Health care Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Health Care System, Department of Veterans Affairs, Los Angeles, California, USA
- Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Evidence-Based Practice Center, RAND Corporation, Santa Monica, CA, USA
| | - Lucinda Leung
- Center for the Study of Health care Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Health Care System, Department of Veterans Affairs, Los Angeles, California, USA
- Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Idamay Curtis
- VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington, USA
- Primary Care Analytics Team, Department of Veterans Affairs, Seattle, Washington, USA
| | - Lawrence Wahlberg
- Department of Veterans Affairs, National Clinical Resource Hub, VA Central Office, Washington, District of Columbia, USA
- Department of Psychiatry, School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Bradford Felker
- VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, Washington, USA
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Hedden L, Spencer S, Mathews M, Gard Marshall E, Lukewich J, Asghari S, Gill P, McCracken RK, Vaughan C, Wong E, Buote R, Meredith L, Moritz L, Ryan D, Schacter G. "Technology has allowed us to do a lot more but it's not necessarily the panacea for everybody": Family physician perspectives on virtual care during the COVID-19 pandemic and beyond. PLoS One 2024; 19:e0296768. [PMID: 38422067 PMCID: PMC10903916 DOI: 10.1371/journal.pone.0296768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/18/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Early in the COVID-19 pandemic, Canadian primary care practices rapidly adapted to provide care virtually. Most family physicians lacked prior training or expertise with virtual care. In the absence of formal guidance, they made individual decisions about in-person versus remote care based on clinical judgement, their longitudinal relationships with patients, and personal risk assessments. Our objective was to explore Canadian family physicians' perspectives on the strengths and limitations of virtual care implementation for their patient populations during the COVID-19 pandemic and implications for the integration of virtual care into broader primary care practice. METHODS We conducted semi-structured qualitative interviews with family physicians working in four Canadian jurisdictions (Vancouver Coastal health region, British Columbia; Southwestern Ontario; the province of Nova Scotia; and Eastern Health region, Newfoundland and Labrador). We analyzed interview data using a structured applied thematic approach. RESULTS We interviewed 68 family physicians and identified four distinct themes during our analysis related to experiences with and perspectives on virtual care: (1) changes in access to primary care; (2) quality and efficacy of care provided virtually; (3) patient and provider comfort with virtual modalities; and (4) necessary supports for virtual care moving forward. CONCLUSIONS The move to virtual care enhanced access to care for select patients and was helpful for family physicians to better manage their panels. However, virtual care also created access challenges for some patients (e.g., people who are underhoused or living in areas without good phone or internet access) and for some types of care (e.g., care that required access to medical devices). Family physicians are optimistic about the ongoing integration of virtual care into broader primary care delivery, but guidance, regulations, and infrastructure investments are needed to ensure equitable access and to maximize quality of care.
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Affiliation(s)
- Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Emily Gard Marshall
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Family Medicine, Faculty of Medicine, Memorial University, St John’s, Newfoundland and Labrador, Canada
| | - Paul Gill
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Rita K. McCracken
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Crystal Vaughan
- Faculty of Nursing, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Richard Buote
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lauren Moritz
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Faculty of Nursing, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Gordon Schacter
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Rubenstein LV, Curtis I, Wheat CL, Grembowski DE, Stockdale SE, Kaboli PJ, Yoon J, Felker BL, Reddy AS, Nelson KM. Learning from national implementation of the Veterans Affairs Clinical Resource Hub (CRH) program for improving access to care: protocol for a six year evaluation. BMC Health Serv Res 2023; 23:790. [PMID: 37488518 PMCID: PMC10367243 DOI: 10.1186/s12913-023-09799-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The Veterans Affairs (VA) Clinical Resource Hub (CRH) program aims to improve patient access to care by implementing time-limited, regionally based primary or mental health staffing support to cover local staffing vacancies. VA's Office of Primary Care (OPC) designed CRH to support more than 1000 geographically disparate VA outpatient sites, many of which are in rural areas, by providing virtual contingency clinical staffing for sites experiencing primary care and mental health staffing deficits. The subsequently funded CRH evaluation, carried out by the VA Primary Care Analytics Team (PCAT), partnered with CRH program leaders and evaluation stakeholders to develop a protocol for a six-year CRH evaluation. The objectives for developing the CRH evaluation protocol were to prospectively: 1) identify the outcomes CRH aimed to achieve, and the key program elements designed to achieve them; 2) specify evaluation designs and data collection approaches for assessing CRH progress and success; and 3) guide the activities of five geographically dispersed evaluation teams. METHODS The protocol documents a multi-method CRH program evaluation design with qualitative and quantitative elements. The evaluation's overall goal is to assess CRH's return on investment to the VA and Veterans at six years through synthesis of findings on program effectiveness. The evaluation includes both observational and quasi-experimental elements reflecting impacts at the national, regional, outpatient site, and patient levels. The protocol is based on program evaluation theory, implementation science frameworks, literature on contingency staffing, and iterative review and revision by both research and clinical operations partners. DISCUSSION Health systems increasingly seek to use data to guide management and decision-making for newly implemented clinical programs and policies. Approaches for planning evaluations to accomplish this goal, however, are not well-established. By publishing the protocol, we aim to increase the validity and usefulness of subsequent evaluation findings. We also aim to provide an example of a program evaluation protocol developed within a learning health systems partnership.
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Affiliation(s)
- Lisa V Rubenstein
- Evidence-Based Practice Center, RAND Corporation, Santa Monica, CA, USA.
- Geffen School of Medicine and Fielding School of Public Health at UCLA, Los Angeles, CA, USA.
| | - Idamay Curtis
- Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Chelle L Wheat
- Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - David E Grembowski
- The Department of Health Systems and Population Health in the School of Public Health, University of Washington, Seattle, USA
| | - Susan E Stockdale
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Peter J Kaboli
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA
| | - Jean Yoon
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Department of General Internal Medicine, UCSF School of Medicine, San Francisco, CA, USA
| | - Bradford L Felker
- Mental Health Service Line, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Ashok S Reddy
- Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Karin M Nelson
- Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Ostovari M, Zhang Z, Patel V, Jurkovitz C. Telemedicine and health disparities: Association between the area deprivation index and primary care telemedicine utilization during the COVID-19 pandemic. J Clin Transl Sci 2023; 7:e168. [PMID: 37588680 PMCID: PMC10425871 DOI: 10.1017/cts.2023.580] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction The rapid implementation of telemedicine during the COVID-19 pandemic may have exacerbated the existing health disparities. This study investigated the association between the area deprivation index (ADI), which serves as a measure of socioeconomic deprivation within a geographic area, and the utilization of telemedicine in primary care. Methods The study data source was electronic health records. The study population consisted of patients with at least one primary care visit between March 2020 and December 2021. The primary outcome of interest was the visit modality (office, phone, and video). The exposure of interest was the ADI score grouped into quartiles (one to four, with one being the least deprived). The confounders included patient sociodemographic characteristics (e.g., age, gender, race, ethnicity, insurance coverage, marital status). We utilized generalized estimating equations to compare the utilization of telemedicine visits with office visits, as well as phone visits with video visits. Results The study population included 41,583 patients with 127,165 office visits, 39,484 phone visits, and 20,268 video visits. Compared to patients in less disadvantaged neighborhoods (ADI quartile = one), patients in more disadvantaged neighborhoods (ADI = two, three, or four) had higher odds of using phone visits vs office visits, lower odds of using video visits vs office visits, and higher odds of using phone visits vs video visits. Conclusions Patients who resided in socioeconomically disadvantaged neighborhoods mainly relied on phone consultations for telemedicine visits with their primary care provider. Patient-level interventions are essential for achieving equitable access to digital healthcare, particularly for low-income individuals.
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Affiliation(s)
- Mina Ostovari
- Christiana Care Health Services Inc., Wilmington, DE, USA
| | - Zugui Zhang
- Christiana Care Health Services Inc., Wilmington, DE, USA
| | - Vishal Patel
- Christiana Care Health Services Inc., Wilmington, DE, USA
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Oh A, Scott JY, Chow A, Jiang H, Dismuke-Greer CE, Gujral K, Yoon J. Rural and urban differences in the implementation of Virtual Integrated Patient-Aligned Care Teams. J Rural Health 2023; 39:272-278. [PMID: 35611882 DOI: 10.1111/jrh.12676] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Workforce shortages contribute to geographic disparities in accessing primary care services. An innovative, clinic-to-clinic videoconferencing telehealth program in the Veterans Health Administration (VHA) called the Virtual Integrated Patient-Aligned Care Teams (V-IMPACT) was designed to increase veterans' access to primary care and relieve workforce shortages in VA primary care clinics, including in many rural areas. This paper describes trends in clinic sites and veteran uptake of the V-IMPACT program, a model that delivered remote, team-based primary care services, from fiscal years (FY)2013-2018. METHODS This observational study used VHA administrative data to compare program uptake, measured by the program penetration rate (percent of patients using V-IMPACT services in each site) across sites; and characteristics for V-IMPACT users versus nonusers for 2,155,203 veteran-years in 69 sites across 7 regional networks for FY2013-2018. Regression models assessed the association between V-IMPACT use and veteran characteristics within sites. FINDINGS Across sites, V-IMPACT had higher penetration in rural sites (8%) and primary care community-based outpatient clinics (7%, P<.001). After adjusting for veteran characteristics, rural veterans (aOR = 1.05; P = .02) and veterans with higher comorbidity risk scores (aOR = 1.08; P<.001) were independently associated with V-IMPACT use. Highly rural veterans (OR = 0.60; P<.001) and veterans who lived ≥40 miles from the closest VHA primary care site (OR = 0.86; P<.001) were less likely to be a V-IMPACT user. CONCLUSIONS A clinic-to-clinic telehealth program, such as V-IMPACT, was able to reach many rural sites, rural veterans, and veterans in primary care health professional shortage areas. V-IMPACT has the potential to increase access to team-based primary care.
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Affiliation(s)
- Anna Oh
- San Francisco VA Health Care System, San Francisco, California, USA.,Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Jennifer Y Scott
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA
| | - Adam Chow
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Hao Jiang
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Clara E Dismuke-Greer
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Kritee Gujral
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Jean Yoon
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA.,Department of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
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Sreedhara M, Suvada K, Bostic M, Scott A, Blum E, Jordan J, Beasley KL. Rapid Evaluations of Telehealth Strategies to Address Hypertension: A Mixed-Methods Exploration at Two US Health Systems During the COVID-19 Pandemic. Prev Chronic Dis 2022; 19:E81. [PMID: 36480804 DOI: 10.5888/pcd19.220219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Telehealth is a promising intervention for hypertension management and control and was rapidly adopted by health systems to ensure continuity of care during the COVID-19 pandemic. Rapid evaluations of telehealth strategies at 2 US health systems explored how telehealth affected health care access and blood pressure outcomes among populations disproportionately affected by hypertension. Both health systems implemented telehealth strategies to maintain continuity of health care services during the COVID-19 pandemic. The evaluations used a mixed-method approach; qualitative interviews were conducted with key staff, and quantitative analyses were performed on patient electronic health record data. Both health systems exhibited similar trends in telehealth use, which allowed for continued access to health care for some patients but hindered other patients who had limited access to the internet or the equipment needed. Telehealth provides opportunities for blood pressure control and management. Further evaluation is needed to understand the role of broadband internet access as a social determinant of health and its impact on equitable patient access to health care.
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Affiliation(s)
- Meera Sreedhara
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mailstop S107-3, Atlanta, GA 30341.
| | - Kara Suvada
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.,Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, Georgia
| | - Myles Bostic
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Amber Scott
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Ethan Blum
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julia Jordan
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kincaid Lowe Beasley
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Eder M, Jacobsen R, Peterson KA, Solberg LI. Quality and team care response to the pandemic stresses in high performing primary care practices: A qualitative study. PLoS One 2022; 17:e0278410. [PMID: 36454787 PMCID: PMC9714700 DOI: 10.1371/journal.pone.0278410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To learn how high performing primary care practices organized care for patients with diabetes during the initial months of the COVID-19 pandemic. PARTICIPANTS AND METHODS Semi-structured interviews were conducted between August 10 and December 10, 2020 with 16 leaders from 11 practices that had top quartile performance measures for diabetes outcomes pre-COVID. Each clinic had completed a similar interview and a survey about the existence of care management systems associated with quality outcomes before the pandemic. Transcript analysis utilized a theoretical thematic analysis at the semantic level. RESULTS The pandemic disrupted the primary care practices' operations and processes considered important for quality prior to the pandemic, particularly clinic reliance on proactive patient care. Safety concerns resulted from the shift to virtual visits, which produced documentation gaps and led practices to reorder their use of proactive patient care processes. Informal interactions with patients also declined. These practices' challenges were mitigated by technical, informational and operational help from the larger organizations of which they were a part. Care management processes had to accommodate both in-person and virtual visits. CONCLUSION These high performing practices demonstrated an ability to adapt their use of proactive patient care processes in pursuing quality outcomes for patients with diabetes during the pandemic. Continued clinic transformation and improvements in quality within primary care depend on the ability to restructure the responsibilities of care team members and their interactions with patients.
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Affiliation(s)
- Milton Eder
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Rachel Jacobsen
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Kevin A. Peterson
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Leif I. Solberg
- HealthPartners Institute, Bloomington, Minnesota, United States of America
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Lewinski AA, Walsh C, Rushton S, Soliman D, Carlson SM, Luedke MW, Halpern DJ, Crowley MJ, Shaw RJ, Sharpe JA, Alexopoulos AS, Tabriz AA, Dietch JR, Uthappa DM, Hwang S, Ball Ricks KA, Cantrell S, Kosinski AS, Ear B, Gordon AM, Gierisch JM, Williams JW, Goldstein KM. Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review. J Med Internet Res 2022; 24:e37100. [PMID: 36018711 PMCID: PMC9463619 DOI: 10.2196/37100] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Extensive literature support telehealth as a supplement or adjunct to in-person care for the management of chronic conditions such as congestive heart failure (CHF) and type 2 diabetes mellitus (T2DM). Evidence is needed to support the use of telehealth as an equivalent and equitable replacement for in-person care and to assess potential adverse effects. OBJECTIVE We conducted a systematic review to address the following question: among adults, what is the effect of synchronous telehealth (real-time response among individuals via phone or phone and video) compared with in-person care (or compared with phone, if synchronous video care) for chronic management of CHF, chronic obstructive pulmonary disease, and T2DM on key disease-specific clinical outcomes and health care use? METHODS We followed systematic review methodologies and searched two databases (MEDLINE and Embase). We included randomized or quasi-experimental studies that evaluated the effect of synchronously delivered telehealth for relevant chronic conditions that occurred over ≥2 encounters and in which some or all in-person care was supplanted by care delivered via phone or video. We assessed the bias using the Cochrane Effective Practice and Organization of Care risk of bias (ROB) tool and the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation. We described the findings narratively and did not conduct meta-analysis owing to the small number of studies and the conceptual heterogeneity of the identified interventions. RESULTS We identified 8662 studies, and 129 (1.49%) were reviewed at the full-text stage. In total, 3.9% (5/129) of the articles were retained for data extraction, all of which (5/5, 100%) were randomized controlled trials. The CHF study (1/5, 20%) was found to have high ROB and randomized patients (n=210) to receive quarterly automated asynchronous web-based review and follow-up of telemetry data versus synchronous personal follow-up (in-person vs phone-based) for 1 year. A 3-way comparison across study arms found no significant differences in clinical outcomes. Overall, 80% (4/5) of the studies (n=466) evaluated synchronous care for patients with T2DM (ROB was judged to be low for 2, 50% of studies and high for 2, 50% of studies). In total, 20% (1/5) of the studies were adequately powered to assess the difference in glycosylated hemoglobin level between groups; however, no significant difference was found. Intervention design varied greatly from remote monitoring of blood glucose combined with video versus in-person visits to an endocrinology clinic to a brief, 3-week remote intervention to stabilize uncontrolled diabetes. No articles were identified for chronic obstructive pulmonary disease. CONCLUSIONS This review found few studies with a variety of designs and interventions that used telehealth as a replacement for in-person care. Future research should consider including observational studies and studies on additional highly prevalent chronic diseases.
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Affiliation(s)
- Allison A Lewinski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- School of Nursing, Duke University, Durham, NC, United States
| | - Conor Walsh
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Sharron Rushton
- School of Nursing, Duke University, Durham, NC, United States
| | - Diana Soliman
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Scott M Carlson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Matthew W Luedke
- Department of Neurology, Duke University Medical Center, Durham, NC, United States
- Neurodiagnostic Center, Durham Veterans Affairs Medical Center, Durham, NC, United States
| | - David J Halpern
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Duke Primary Care, Duke University Medical Center, Durham, NC, United States
| | - Matthew J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Ryan J Shaw
- School of Nursing, Duke University, Durham, NC, United States
| | - Jason A Sharpe
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Anastasia-Stefania Alexopoulos
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, Corvallis, OR, United States
| | - Diya M Uthappa
- Doctor of Medicine Program, Duke University School of Medicine, Durham, NC, United States
| | - Soohyun Hwang
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Katharine A Ball Ricks
- Cecil G Sheps Center for Health Service Research, University of North Carolina, Chapel Hill, NC, United States
| | - Sarah Cantrell
- Duke University Medical Center Library, Duke University School of Medicine, Durham, NC, United States
| | - Andrzej S Kosinski
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States
| | - Belinda Ear
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Adelaide M Gordon
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Jennifer M Gierisch
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - John W Williams
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Karen M Goldstein
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
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10
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Sitter KE, Wong DH, Bolton RE, Vimalananda VG. Clinical appropriateness of telehealth: a qualitative study of endocrinologists’ perspectives. J Endocr Soc 2022; 6:bvac089. [DOI: 10.1210/jendso/bvac089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Outpatient endocrinology care delivered by telehealth is likely to remain common post-pandemic. There is little data to guide endocrinologists’ judgments of clinical appropriateness (safety and effectiveness) for telehealth by synchronous video. We examined how, in the absence of guidelines, endocrinologists determine clinical appropriateness for telehealth, and we identified their strategies to navigate barriers to safe and effective use.
Methods
We conducted qualitative, semi-structured interviews with 26 purposively selected US endocrinologists. We used a directed content analysis to characterize participant perceptions of which patients and situations were clinically appropriate for telehealth, and to identify adaptations they made to accommodate telehealth visits.
Results
Endocrinologists’ perspectives about appropriateness for telehealth were influenced by clinical considerations, non-clinical patient factors, and the type and timing of the visit. These factors were weighed differently across individual participants according to their risk tolerance, values related to the physical exam and patient relationships, and impressions of patient capabilities and preferences. Some participants made practice adaptations that increased their comfort offering telehealth to a wider swath of patients.
Conclusions
Endocrinologists’ judgments about clinical appropriateness of telehealth for different patient situations varied widely across participants. The risk of such divergent approaches to determining appropriateness is unintended and clinically unwarranted variation in use of telehealth, compromising quality of care. Expert consensus is needed to guide endocrinologists now, along with studies to anchor future evidence-based guidelines for determining clinical appropriateness of telehealth in endocrinology.
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Affiliation(s)
- Kailyn E Sitter
- Center for Healthcare Organization and Implementation Research , VA Bedford Healthcare System, Bedford MA
| | - Denise H Wong
- Center for Healthcare Organization and Implementation Research , VA Bedford Healthcare System, Bedford MA
- Section of Endocrinology, Diabetes, Nutrition and Weight Management , Boston University School of Medicine, Boston MA
| | - Rendelle E Bolton
- Center for Healthcare Organization and Implementation Research , VA Bedford Healthcare System, Bedford MA
- The Heller School for Social Policy and Management , Brandeis University, Waltham MA
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research , VA Bedford Healthcare System, Bedford MA
- Section of Endocrinology, Diabetes, Nutrition and Weight Management , Boston University School of Medicine, Boston MA
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11
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Price ST, Mainous AG, Rooks BJ. Survey of cancer screening practices and telehealth services among primary care physicians during the COVID-19 pandemic. Prev Med Rep 2022; 27:101769. [PMID: 35313453 PMCID: PMC8928753 DOI: 10.1016/j.pmedr.2022.101769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/22/2022] [Accepted: 03/13/2022] [Indexed: 02/07/2023] Open
Abstract
The COVID-19 pandemic resulted in rapid implementation of telehealth within primary care impacting cancer screening. We sought to assess the impact of increased telehealth use on physician recommendation for cancer screenings during the COVID-19 pandemic in North America. Primary care physicians (n = 757) were surveyed in Fall 2020 through the Council of Academic Family Medicine's Educational Research Alliance (CERA) general membership survey. Respondents were asked about cancer screening practices and telehealth services during the COVID-19 pandemic. Chi-squared tests were performed to assess relationships between cancer screening practices and changes in care necessitated by the shift to telehealth services. Associations between participant responses and those reporting a diminished patient-provider relationship were assessed with multivariable logistic regression. A substantial proportion of respondents reported postponing screening for breast (34.5%), colon (32.9%), and cervical cancer (31%), and a majority (51.1%) agreed changes in care seeking will lead to increased incidence of late stage cancer. Physicians reported high use of telehealth during the pandemic, but endorsed limitations in its use to maintain cancer screening practices and the patient-provider relationship. Physicians who reported patients were afraid to come into the office were more likely to report an impaired patient-provider relationship (OR = 2.77, 95% CI: 1.33 - 7.87). Physicians who reported that telehealth maintains their patient-provider relationship were less likely to report an impaired patient-provider relationship (OR = 0.33, 95% CI: 0.17 - 0.67). As telehealth becomes increasingly prominent, evaluation of the impact of telehealth on cancer screening and patient-provider relationships will be increasingly important for primary care.
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Affiliation(s)
- Sarah T. Price
- Department of Family Medicine, Medical University of South Carolina, 135 Cannon Street, Suite 405 MSC 192, Charleston 29425, USA
| | - Arch G. Mainous
- Department of Community Health and Family Medicine, University of Florida, 1329 SW 16 Street 4270, Gainesville 32608, USA
- Department of Health Services Research, 1225 Center Drive, University of Florida, Gainesville 32603, USA
| | - Benjamin J. Rooks
- Department of Health Services Research, 1225 Center Drive, University of Florida, Gainesville 32603, USA
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12
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Quinton JK, Ong MK, Sarkisian C, Casillas A, Vangala S, Kakani P, Han M. The Impact of Telemedicine on Quality of Care for Patients with Diabetes After March 2020. J Gen Intern Med 2022; 37:1198-1203. [PMID: 35091921 PMCID: PMC8796744 DOI: 10.1007/s11606-021-07367-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND The impact of telemedicine on ambulatory care quality is a key question for policymakers as they navigate payment reform for remote care. OBJECTIVE To evaluate whether utilizing telemedicine in the first 9 months of the COVID-19 pandemic impacted performance on a diabetes quality of care measure for patients at a large academic medical center. We hypothesized care quality would reduce less among telemedicine users. DESIGN Quasi-experimental design using binomial logistic regression. Covariates included age, gender, race, ethnicity, type of insurance, hierarchical condition category score, primary language at the individual level, and zip code-level income. PARTICIPANTS All adult patients younger than 75 years of age diagnosed with type 2 diabetes mellitus (N = 16,588) as of 3/19/2020 at a single academic health center. INTERVENTIONS Completion of one or more telemedicine encounters with an institutional primary care physician or endocrinologist between 3/19/2020 and 12/19/2020. MAIN MEASURES The components met in a five-item composite measure of diabetes quality of care, as of patients' last clinical encounter. Items were (1) systolic blood pressure less than 140 mmHg, (2) hemoglobin A1c less than 8.0%, (3) using a statin and (4) aspirin, and (5) tobacco non-use. KEY RESULTS From the pre- to post-period, the probability of meeting any given component of the composite measure for patients only utilizing in-person care was 21% lower (OR, 95% CI 0.79; 0.76, 0.81) and for the telemedicine users 2% lower (OR 0.98; 0.85, 1.13). There was an increased likelihood of meeting any given component among telemedicine users compared to in-person care alone (OR 1.25; 1.08, 1.44). CONCLUSIONS Patients with diabetes utilizing telemedicine performed similarly on a composite measure of diabetes care quality compared to before the pandemic. Those not utilizing telemedicine had reductions. Telemedicine use maintained quality of care for patients with diabetes during the first 9 months of the COVID-19 pandemic.
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Affiliation(s)
- Jacob K Quinton
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, 1100 Glendon Ave, Suite 900, Los Angeles, CA, 90024, USA.
| | - Michael K Ong
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, 1100 Glendon Ave, Suite 900, Los Angeles, CA, 90024, USA
- Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
- VA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA
| | - Catherine Sarkisian
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, 1100 Glendon Ave, Suite 900, Los Angeles, CA, 90024, USA
- Geriatrics Research Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, 1100 Glendon Ave, Suite 900, Los Angeles, CA, 90024, USA
| | - Sitaram Vangala
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, 1100 Glendon Ave, Suite 900, Los Angeles, CA, 90024, USA
| | - Preeti Kakani
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Maria Han
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, 1100 Glendon Ave, Suite 900, Los Angeles, CA, 90024, USA
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13
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Vickery KD, Novotny PJ, Ford BR, Sia IG, Lantz K, Kavistan S, Singh D, Hernandez V, Wieland ML. Experiences of Hispanic Safety Net Clinic Patients With Diabetes During the COVID-19 Pandemic. Sci Diabetes Self Manag Care 2022; 48:87-97. [PMID: 35118926 PMCID: PMC9044409 DOI: 10.1177/26350106221076037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to characterize the material, health (general and diabetes-specific), and social impacts of the COVID-19 pandemic on Hispanic adults with type 2 diabetes who did not experience COVID-19 infection. METHODS This cross-sectional and longitudinal study used surveys within a clinical trial of 79 Hispanic adult clinic patients with type 2 diabetes. Cross-sectional measures included the Coronavirus Anxiety Scale, items from the Coronavirus Impact Scale, and the Pandemic Impacts Inventory. Longitudinal measures included the Summary of Diabetes Self-Care, health care utilization, and measures of diabetes self-efficacy, social support, and quality of life. RESULTS Participants were majority low-income, Spanish-speaking females with poor diabetes control. Coronavirus anxiety was low despite majority of participants having an affected family member and frequent access barriers. More than half of participants reported moderate/severe pandemic impact on their income. Diabetes self-care behaviors did not change between prepandemic and pandemic measures. Diabetes self-efficacy and quality of life improved despite fewer diabetes-related health care visits. CONCLUSIONS Despite high levels of access barriers, financial strain, and COVID-19 infection of family members, Hispanic adults with type 2 diabetes continued to prioritize their diabetes self-management and demonstrated substantial resilience by improving their self-efficacy and quality of life.
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Affiliation(s)
- Katherine D. Vickery
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis MN
- Division of General Internal Medicine, Hennepin Healthcare, Minneapolis MN
- Health Care for the Homeless, Hennepin County Public Health Department, Minneapolis MN
| | - Paul J. Novotny
- Department of Medicine, Mayo Clinic, Rochester MN and Phoenix, AZ
| | - Becky R. Ford
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis MN
| | - Irene G. Sia
- Department of Medicine, Mayo Clinic, Rochester MN and Phoenix, AZ
| | - Kiley Lantz
- Department of Medicine, Mayo Clinic, Rochester MN and Phoenix, AZ
| | - Silvio Kavistan
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis MN
| | - Davinder Singh
- Department of Medicine, Mayo Clinic, Rochester MN and Phoenix, AZ
- Mountain Park Health Center, Phoenix AZ
| | | | - Mark L. Wieland
- Department of Medicine, Mayo Clinic, Rochester MN and Phoenix, AZ
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14
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Health System Resiliency and the COVID-19 Pandemic: A Case Study of a New Nationwide Contingency Staffing Program. Healthcare (Basel) 2022; 10:healthcare10020244. [PMID: 35206859 PMCID: PMC8872234 DOI: 10.3390/healthcare10020244] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/15/2022] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
When COVID-19 emerged, the U.S. Veterans Health Administration (VA) was in the process of implementing a national contingency staffing program called Clinical Resource Hubs (CRHs). CRHs were intended to provide regional contingency staffing for primary and mental health clinics experiencing staffing shortages primarily through telehealth. Long-term plans (year 2) included emergency management support. Early in the implementation, we conducted semi-structured interviews with CRH directors and national program leaders (n = 26) and used a rapid analysis approach to identify actions taken by CRHs to support the resiliency of the VA healthcare system during the pandemic. We found that the CRH program was flexible and nimble enough to allow VA to leverage providers at hubs to better respond to the demands of COVID-19. Actions taken at hubs to sustain patient access and staff resiliency during the pandemic included supporting call centers and training VA providers on virtual care delivery. Factors that facilitated CRH’s emergency response included hub staff expertise in telehealth and the increased acceptability of virtual care among key stakeholders. We conclude that hub providers serving as contingency staff, as well as specialization in delivering virtual outpatient and inpatient care, enabled VA health system resiliency and recovery during the COVID-19 pandemic.
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15
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Mog AC, Moldestad M, Kenney R, Stevenson L, Lee M, Ho PM, Sayre GG. “I was Unsure at First”: A Qualitative Evaluation of Patient Perceptions of VA Clinical Video Telehealth Visits in the V-IMPACT Program. J Patient Exp 2022; 9:23743735221107237. [PMID: 35813242 PMCID: PMC9260561 DOI: 10.1177/23743735221107237] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Virtual Integrated Multi-Site Patient Aligned Care Team (V-IMPACT) was a Veterans Health
Administration (VHA) initiative created to increase access to primary care for Veterans
through Clinical Video Telehealth (CVT) appointments. Between January and August 2019, we
conducted 48 semi-structured qualitative interviews with Veterans who had a V-IMPACT
appointment. Many participants shared feelings of skepticism before their first
appointments but for some, their opinions changed. Veterans talked about how their opinion
of video care changed for the better when it made care more convenient or timelier or met
their health care needs. For some Veterans, their opinion about video care stayed the same
or worsened because they had a poor relationship or rapport with their provider, did not
feel like they received needed care, or did not feel like video care was useful. These
findings offer an opportunity for telecare providers to better understand and support
patients and to deliver effective care in the context of rapidly growing telehealth
modalities.
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Affiliation(s)
- Ashley C Mog
- The VA Collaborative Evaluation Center (VACE), Seattle, WA, Aurora, CO, Cleveland, OH, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Megan Moldestad
- The VA Collaborative Evaluation Center (VACE), Seattle, WA, Aurora, CO, Cleveland, OH, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Rachael Kenney
- The VA Collaborative Evaluation Center (VACE), Seattle, WA, Aurora, CO, Cleveland, OH, USA
- Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA
| | - Lauren Stevenson
- The VA Collaborative Evaluation Center (VACE), Seattle, WA, Aurora, CO, Cleveland, OH, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Marcie Lee
- The VA Collaborative Evaluation Center (VACE), Seattle, WA, Aurora, CO, Cleveland, OH, USA
- Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA
| | - P Michael Ho
- The VA Collaborative Evaluation Center (VACE), Seattle, WA, Aurora, CO, Cleveland, OH, USA
- Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA
- University of Colorado Anschutz, Aurora, CO, USA
| | - George G Sayre
- The VA Collaborative Evaluation Center (VACE), Seattle, WA, Aurora, CO, Cleveland, OH, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
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16
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Gujral K, Scott JY, Ambady L, Dismuke-Greer CE, Jacobs J, Chow A, Oh A, Yoon J. A Primary Care Telehealth Pilot Program to Improve Access: Associations with Patients' Health Care Utilization and Costs. Telemed J E Health 2021; 28:643-653. [PMID: 34559017 DOI: 10.1089/tmj.2021.0284] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The Veterans Health Administration (VHA) piloted an innovative video telehealth program called Virtual Integrated Multisite Patient Aligned Care Teams (V-IMPACT) in fiscal year (FY) 2014. V-IMPACT set up one regional "hub" site where primary care (PC) teams provided regular PC through telehealth services to patients in outlying "spoke" sites that experienced gaps in provider coverage. We evaluated associations between clinic-level adoption of V-IMPACT and patients' utilization and VHA's costs for primary, emergency, and inpatient care. Materials and Methods: This observational study used repeated cross-sections of 208,612 unique veteran patients assigned to a PC team in 22 V-IMPACT spoke sites from FY2013 to FY2018. V-IMPACT adoption in a spoke site was indicated if more than 1% of patients assigned to PC in a site used V-IMPACT services during the year. Association between V-IMPACT adoption and outcomes were assessed using mixed-effects models. Results: V-IMPACT adoption was associated with increased telehealth visits for PC (incidence rate ratio [IRR] = 2.42 [1.29 to 4.55]) and for primary care mental health integration (IRR = 7.25 [2.69 to 19.54]). V-IMPACT adoption was not associated with in-person visits, or with total visits (in-person plus video telehealth). V-IMPACT adoption was also not associated with acute hospital stays, emergency department visits, or VHA costs. Conclusions: Programs such as VHA's V-IMPACT can increase telehealth visits for PC, allowing successful transition across modalities and facilitating continuity of care without impacting total care. Programs should track substitution of in-person visits with telehealth visits and examine its effects on patients' health outcomes, satisfaction, and travel costs.
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Affiliation(s)
- Kritee Gujral
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Jennifer Y Scott
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA
| | - Leena Ambady
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Clara E Dismuke-Greer
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Josephine Jacobs
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Adam Chow
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Anna Oh
- Division of Geriatrics, Department of Medicine, UCSF, San Francisco, California, USA.,San Francisco VA Health Care System, San Francisco, California, USA
| | - Jean Yoon
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA.,Department of General Internal Medicine, UCSF School of Medicine, San Francisco, California, USA
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