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Farford BA, Bulbarelli EM, Ricketts I, Nath S, Ahuja AS, Keith J. Accuracy of Telehealth Visits for Acute Care Needs in Family Medicine. Cureus 2024; 16:e59569. [PMID: 38832206 PMCID: PMC11144591 DOI: 10.7759/cureus.59569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction As primary care practices transition to a post-pandemic system of healthcare, it is important to recognize the benefits of offering telehealth services. Little research is available on the effectiveness of telehealth visits for managing acute illnesses or conditions in primary care practice. Methods Using the reporting functionality in the Epic™ electronic health record (EHR) (Epic Systems Corporation, Verona), a report was generated to identify all telehealth visit encounters that were completed in a family medicine clinic from March 1, 2020, to June 30, 2020. The report identified patients who had an acute complaint and required an in-office visit within 60 days of the telehealth encounter. If the patient required a face-to-face visit, that was not directed by the provider, the chart was reviewed to determine whether the diagnosis changed. The primary outcome was returning for a face-to-face visit within 30 days of the telehealth visit for the same acute need. Results The cohort included 349 telehealth visits for 303 patients. For patients who had more than one telehealth visit, only the first one was included in the analysis. Among the 303 patients, 50 (16.5%) returned for a face-to-face visit within 30 days of the telehealth visit (95% confidence interval: 12.5%-21.2%), and 71 (23.6%) returned for a telehealth visit within 60 days (95% confidence interval: 18.9%-28.8%). Furthermore, 19 of the 50 patients (38%) that returned for a face-to-face visit did not have a change in diagnosis, and, in some instances, the diagnosis made on the telehealth visit was only slightly different from the face-to-face visit. Discussion and conclusion Telehealth, specifically two-way, synchronous, interactive patient-provider communication through audio and video equipment, for acute care needs in a primary care practice helps reduce the need for in-person visits and can address patient complaints without the need for in-person follow-up.
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Affiliation(s)
| | | | | | - Sahil Nath
- Family Medicine, Mayo Clinic, Jacksonville, USA
| | - Abhimanyu S Ahuja
- Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Josh Keith
- Family Medicine, Mayo Clinic, Jacksonville, USA
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Whitehead DC, Li KY, Hayden E, Jaffe T, Karam A, Zachrison KS. Evaluating the Quality of Virtual Urgent Care: Barriers, Motivations, and Implementation of Quality Measures. J Gen Intern Med 2024; 39:731-738. [PMID: 38302813 PMCID: PMC11043309 DOI: 10.1007/s11606-024-08636-7] [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] [Received: 06/26/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Experts estimate virtual urgent care programs could replace approximately 20% of current emergency department visits. In the absence of widespread quality guidance to programs or quality reporting from these programs, little is known about the state of virtual urgent care quality monitoring initiatives. OBJECTIVE We sought to characterize ongoing quality monitoring initiatives among virtual urgent care programs. APPROACH Semi-structured interviews of virtual health and health system leaders were conducted using a pilot-tested interview guide to assess quality metrics captured related to care effectiveness and equity as well as programs' motivations for and barriers to quality measurement. We classified quality metrics according to the National Quality Forum Telehealth Measurement Framework. We developed a codebook from interview transcripts for qualitative analysis to classify motivations for and barriers to quality measurement. KEY RESULTS We contacted 13 individuals, and ultimately interviewed eight (response rate, 61.5%), representing eight unique virtual urgent care programs at primarily academic (6/8) and urban institutions (5/8). Most programs used quality metrics related to clinical and operational effectiveness (7/8). Only one program reported measuring a metric related to equity. Limited resources were most commonly cited by participants (6/8) as a barrier to quality monitoring. CONCLUSIONS We identified variation in quality measurement use and content by virtual urgent care programs. With the rapid growth in this approach to care delivery, more work is needed to identify optimal quality metrics. A standardized approach to quality measurement will be key to identifying variation in care and help focus quality improvement by virtual urgent care programs.
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Affiliation(s)
- David C Whitehead
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | | | - Emily Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Todd Jaffe
- University of Pennsylvania, Philadelphia, PA, USA
| | - Alessandra Karam
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Wray CM, Junge M, Keyhani S, Smith JE. Assessment of a multi-center tele-urgent care program to decrease emergency department referral rates in the Veterans Health Administration. J Telemed Telecare 2023; 29:749-754. [PMID: 34152876 DOI: 10.1177/1357633x211024843] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The use of emergency departments for non-emergent issues has led to overcrowding and decreased the quality of care. Telemedicine may be a mechanism to decrease overutilization of this expensive resource. From April to September 2020, we assessed (a) the impact of a multi-center tele-urgent care program on emergency department referral rates and (b) the proportion of individuals who had a subsequent emergency department visit within 72 h of tele-urgent care evaluation when they were not referred to the emergency department. We then performed a chart review to assess whether patients presented to the emergency department for the same reason as was stated for their tele-urgent care evaluation, whether subsequent hospitalization was needed during that emergency department visit, and whether death occurred. Among the 2510 patients who would have been referred to in-person emergency department care, but instead received tele-urgent care assessment, one in five (21%; n = 533) were subsequently referred to the emergency department. Among those not referred following tele-urgent care, 1 in 10 (11%; n = 162) visited the emergency department within 72 h. Among these 162 individuals, most (91%) returned with the same or similar complaint as what was assessed during their tele-urgent care visit, with one in five requiring hospitalization (19%, n = 31) with one individual (0.01%) dying. In conclusion, tele-urgent care may safely decrease emergency department utilization.
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Affiliation(s)
- Charlie M Wray
- Department of Medicine, University of California, San Francisco, USA
- Section of Hospital Medicine, San Francisco Veterans Affairs Medical Center, USA
| | - Myla Junge
- Section of Emergency Medicine, San Francisco Veterans Affairs Medical Center, USA
| | - Salomeh Keyhani
- Department of Medicine, University of California, San Francisco, USA
- Section of General Internal Medicine, San Francisco Veterans Affairs Medical Center, USA
| | - Janeen E Smith
- Department of Medicine, University of California, San Francisco, USA
- Section of Emergency Medicine, San Francisco Veterans Affairs Medical Center, USA
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Mettler AC, Aebersold ER, Piazza L, Schmid S, Michel J, Müller M, Exadaktylos AK, Sauter TC. Telehealth use by walk-in patients who subsequently visited an academic emergency department: a repeated cross-sectional study during the COVID-19 summer 2021. Swiss Med Wkly 2023; 153:40027. [PMID: 36787447 DOI: 10.57187/smw.2023.40027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
AIM OF THE STUDY During the COVID-19 pandemic, telehealth use increased worldwide in a variety of medical specialities and reached new population groups. A baseline survey of telehealth use prior to admission to the emergency department (ED) conducted before COVID-19 concluded that predominantly well-educated men used telehealth. It is unclear how COVID-19 changed the use of telehealth in Swiss emergency patients. We therefore aimed to investigate (i) the frequency of telehealth use during the pandemic, and (ii) how the pandemic has influenced telehealth use and users. MATERIALS AND METHODS A repeated cross-sectional study was conducted among ED walk-in patients at a tertiary university hospital in Switzerland. The study took place one and a half years after the first confirmed COVID-19 case, during 30 shifts from 8 to 29 July 2021 and compared with the baseline survey conducted in 2019. Eligible patients were questioned about their use of, and attitudes to telehealth. RESULTS A total of 1020 patients were screened for the COVID survey and 443 complete questionnaires were evaluated. A trend towards a general increase (+6.4%) in telehealth use was demonstrated (50.3%, n = 223 COVID survey vs 43.9%, n = 183 baseline survey; p = 0.058), with a shift to more female patients using telehealth in the COVID survey (female 54.9%, n = 124 vs 45.1%, n = 102; p = 0.052). During the pandemic, first use of telehealth was reported by 12.2% (n = 54) of patients, with a significant increase among patients with low educational status, and the latter patients often indicated that they did not plan to use telehealth after the pandemic. The perceived usefulness of telehealth and adherence to recommendations increased in the COVID survey compared with the baseline survey (adherence 90.3%, n = 149, vs 78.0%, n = 131; p = 0.002). CONCLUSION We found a trend towards increased use of telehealth among Swiss ED patients. First-time users of telehealth were predominantly less educated and inclusion of these user groups may not be sustainable, as was indicated by the patients. COVID-19 led to greater adherence to telehealth recommendations and higher perceived usefulness. This could be due to the limited access to healthcare providers due to pandemic precautions. When offering telehealth, the needs of all patient groups must be considered, in order to ensure that telehealth provides the greatest benefit with lower barriers to use.
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Affiliation(s)
- Annette C Mettler
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Eli R Aebersold
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Livio Piazza
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sandra Schmid
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Janet Michel
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Cheng O, Hu JY, Hong J, Sarad N, Zenilman ME, Chen CC, Fahoum B, Lee RS. Operative Management of Acute Appendicitis is Safe During the COVID-19 Pandemic Shutdown. J Surg Res 2023; 287:117-123. [PMID: 36924622 PMCID: PMC9892322 DOI: 10.1016/j.jss.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 12/15/2022] [Accepted: 01/21/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION In the spring of 2020, New York City was one of the first epicenters of the COVID outbreak. In this study, we evaluate the incidence and treatment of appendicitis in two New York City community hospitals during the COVID pandemic. METHODS This retrospective study focused on the incidence and outcome of acute appendicitis in the adult population (>18 y old) during peak-COVID periods (March 16, 2020,-June 15, 2020) compared to pre-COVID and post-COVID periods. We compared the number of patients who underwent operative versus nonoperative management, patient demographics, length of stay (LOS), complications, and readmission rates within these time periods. Data are presented as mean ± standard deviation (analysis of variance). RESULTS From January 1, 2020 to December 31, 2020, 393 patients presented with acute appendicitis and 321 (81.7%) were treated operatively, compared to 441 total and 366 treated operatively (83%) in 2019 (P = 0.88). During the COVID outbreak, fewer patients presented with appendicitis (mean 6.9 ± 1 pre-COVID case/week, 4.4 ± 2.4 peak-COVID cases/week and 7.6 ± 0.65 post-COVID cases/week, P = 0.018) with no significant difference in the pre-COVID and post-COVID period. There was no difference in LOS between the pre-, peak-, and post-COVID periods with a median of 1 for all the three, (interquartile range (IQR): 0.8-2, 0.6-2, 0.6-2, respectively, P = 0.43). Additionally, there was no difference in 30-day readmission rates (4.2%, 0%, 3.9%, P = 0.99) and postoperative complications (4.2%, 0%, 2.9%, P = 0.98). CONCLUSIONS During peak-COVID, there was a significant reduction in the number of patients who presented with acute appendicitis without a post rebound increase in presentation. Those who presented during peak-COVID were able to undergo operative management safely, without affecting LOS or postoperative complications.
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Affiliation(s)
- Olivia Cheng
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York.
| | - James Y Hu
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Julie Hong
- New York-Presbyterian Queens Hospital, Flushing, New York
| | - Nakia Sarad
- New York-Presbyterian Queens Hospital, Flushing, New York
| | | | | | - Bashar Fahoum
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Roseanna S Lee
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
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Farzandipour M, Nabovati E, Sharif R. The effectiveness of tele-triage during the COVID-19 pandemic: A systematic review and narrative synthesis. J Telemed Telecare 2023:1357633X221150278. [PMID: 36683438 PMCID: PMC9892819 DOI: 10.1177/1357633x221150278] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/21/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Telehealth services were used by healthcare centers during the COVID-19 pandemic in order to identify and manage patients at the forefront of the healthcare system. As one of these technologies, tele-triage refers to the assessment of a patient's health status through telephone or another means of communication and recommending treatment or providing appropriate referrals in emergency rooms and primary care offices. This study aimed to perform a systematic review of the evidence on the effectiveness of tele-triage, as one of these technologies, during the COVID-19 pandemic. METHODS Medline (via PubMed), Scopus, and Web of Science databases were searched for relevant English articles published since the pandemic's onset until December 30, 2021. Studies investigating the tele-triage's effect on patient safety, clinical outcomes, and patient satisfaction were included. Data on study characteristics, intervention characteristics, and their effects on study outcomes were extracted separately by two authors. A narrative synthesis of the included studies was ultimately performed. RESULTS Out of the 6312 retrieved studies, 14 met the inclusion criteria. The tele-triage intervention was offered by an algorithm-based system in eight studies (57.14%) and by healthcare providers in six other studies (42.86%) to determine the patient's level of care. According to the results, tele-triage interventions during COVID-19 can reduce unnecessary emergency room visits (by 1.2-22.2%), improve clinical outcomes after intervention (such as would closure in diabetic feet), reduce mortality and injuries, and ensure patient satisfaction with tele-triage (53-98%). CONCLUSIONS This study found that tele-triage interventions reduced unnecessary visits, improved clinical outcomes, reduced mortality, and injuries, increased patient satisfaction, reduced healthcare provider workload, improved access to primary care consultation, and increased patient safety and satisfaction. Therefore, tele-triage systems are not only suitable for providing acute and emergency care remotely but they are also recommended as an alternative tool to monitor and diagnose COVID-19.
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Affiliation(s)
- Mehrdad Farzandipour
- Health Information Management Research Center, Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Ehsan Nabovati
- Health Information Management Research Center, Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Reihane Sharif
- Health Information Management Research Center, Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
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Hall JN, Ackery AD, Dainty KN, Gill PS, Lim R, Masood S, McLeod SL, Mehta S, Nijmeh L, Rosenfield D, Rutledge G, Verma A, Mondoux S. Designs, facilitators, barriers, and lessons learned during the implementation of emergency department led virtual urgent care programs in Ontario, Canada. Front Digit Health 2022; 4:946734. [PMID: 36093385 PMCID: PMC9448924 DOI: 10.3389/fdgth.2022.946734] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionVirtual patient care has seen incredible growth since the beginning of the COVID-19 pandemic. To provide greater access to safe and timely urgent care, in the fall of 2020, the Ministry of Health introduced a pilot program of 14 virtual urgent care (VUC) initiatives across the province of Ontario. The objective of this paper was to describe the overall design, facilitators, barriers, and lessons learned during the implementation of seven emergency department (ED) led VUC pilot programs in Ontario, Canada.MethodsWe assembled an expert panel of 13 emergency medicine physicians and researchers with experience leading and implementing local VUC programs. Each VUC program lead was asked to describe their local pilot program, share common facilitators and barriers to adoption of VUC services, and summarize lessons learned for future VUC design and development.ResultsModels of care interventions varied across VUC pilot programs related to triage, staffing, technology, and physician remuneration. Common facilitators included local champions to guide program delivery, provincial funding support, and multi-modal marketing and promotions. Common barriers included behaviour change strategies to support adoption of a new service, access to high-quality information technology to support new workflow models that consider privacy, risk, and legal perspectives, and standardized data collection which underpin overall objective impact assessments.ConclusionsThese pilot programs were rapidly implemented to support safe access to care and ED diversion of patients with low acuity issues during the COVID-19 pandemic. The heterogeneity of program implementation respects local autonomy yet may present challenges for sustainability efforts and future funding considerations.
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Affiliation(s)
- Justin N. Hall
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Correspondence: Justin N. Hall
| | - Alun D. Ackery
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, St. Michael’s Hospital, Unity Health, Toronto, ON, Canada
| | - Katie N. Dainty
- Department of Research and Innovation, North York General Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Paul S. Gill
- Department of Community and Family Medicine, University of Toronto, Toronto, ON, Canada
| | - Rodrick Lim
- Department of Paediatrics and Medicine, Western University, London, ON, Canada
| | - Sameer Masood
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Services, University Health Network, Toronto, ON, Canada
| | - Shelley L. McLeod
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Community and Family Medicine, University of Toronto, Toronto, ON, Canada
- Schwartz/Reisman Emergency Medicine Institute (SREMI), Mount Sinai Hospital, Toronto, ON, Canada
| | - Shaun D. Mehta
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, St. Michael’s Hospital, Unity Health, Toronto, ON, Canada
| | - Larry Nijmeh
- Department of Community and Family Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, Lakeridge Health, Oshawa, ON, Canada
- Department of Family Medicine, Queen’s University, Kingston, ON, Canada
| | - Daniel Rosenfield
- Division of Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Greg Rutledge
- Department of Emergency Medicine, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Aikta Verma
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shawn Mondoux
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
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Diaz VA, Su Z, King KL, Ford DW, Kruis RD, Marsden JE, Cooper NA, Mauldin PD, Player MS. Preventive Care Utilization by Patients Who Use Virtual Urgent Care. Telemed J E Health 2022; 28:1458-1463. [PMID: 35333636 DOI: 10.1089/tmj.2021.0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The use of direct to patient (DTP) telemedicine for common acute conditions is widespread. It provides certain advantages over in-person visits, but has led to concerns about fragmentation of care. It is unknown whether use of DTP telemedicine decreases use of primary care services in a way that leads to missed preventive screenings and immunizations. Methods: Virtual urgent care (VUC) is a DTP telemedicine service to treat common acute conditions. All VUC encounters completed at an academic health system from July 2018 to December 2019 were evaluated and analyzed in 2020. Only patients established with primary care (at least one primary care visit in the same year as VUC encounter) were included. Specific preventive screenings (breast cancer, gonorrhea/chlamydia, and cervical cancer) and immunizations (tetanus and influenza) were characterized as up to date based on national guidelines. Chi-squares and multivariate logistic regressions were used to assess receipt of screenings and immunizations. Regressions included VUC and primary care utilization and demographic factors. Results: Patients evaluated (N = 1025) were mostly 25-50 years old (69.7%), women (81.8%), and white (74.9%). More than half (56.5%) had only used VUC once. In multivariate analyses, VUC utilization was not negatively associated with any of the preventive services evaluated, whereas primary care utilization was associated with receipt of both immunizations and gonorrhea/chlamydia screening. Conclusions: Higher VUC utilization is not negatively associated with receipt of preventive services, as long as a primary care relationship is established. VUC may provide a useful method of encouraging receipt of preventive services, especially for younger patients.
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Affiliation(s)
- Vanessa A Diaz
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zemin Su
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kathryn L King
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dee W Ford
- Department of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ryan D Kruis
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Justin E Marsden
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicole A Cooper
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Patrick D Mauldin
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marty S Player
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Yoon C, Lee J, Fong E, Lee JI. The Virtual Team Member: Remote Engagement of Medical Students in COVID-19 Care. MEDICAL SCIENCE EDUCATOR 2021; 31:1831-1838. [PMID: 34692228 PMCID: PMC8525619 DOI: 10.1007/s40670-021-01422-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
Background Medical education abruptly changed in the setting of the COVID-19 pandemic, impacting experiential learning in clinical clerkship as medical students were removed from direct patient interactions and care team participation. Re-configuring a hospital clinical rotation using virtual care platforms allowed students to re-engage in the clinical environment and actively participate in patient care. Methods During the height of the pandemic, we implemented a 4-week "virtual team member" (VTM) inpatient medicine elective for medical students in their second year and above to participate in acute patient care during the height of the COVID-19 pandemic. Tasks included providing daily updates to patients and family members along and care coordination. Faculty experts in infectious disease, mental health, ethics, and patient safety incorporated weekly didactic video talks throughout the elective. Student feedback was obtained anonymously through pre-, mid-, and post-elective questionnaires. Results A total of 26 students enrolled in the two 4-week blocks, with 85% in the 2nd year. Survey response rates for the pre, mid, and post-rotation questionnaires were 96%, 77%, 58% respectively. Of the 15 students who completed the post-survey, the majority strongly and somewhat agreed that the elective met expectations (12/15, 80%), was worthwhile (14/15, 93%) and met goals (12/15, 80%). Best parts of the elective most frequently cited by students were patient care and teamwork. Working remotely was the greatest challenge. Conclusions Designing a virtual role for students successfully allowed students to re-engage in the acute care setting and connect with patients and participate in COVID-19 care. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-021-01422-8.
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Affiliation(s)
- Cecilia Yoon
- Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 53 West 23rd street, 6th floor, New York, NY USA
| | - Jihui Lee
- Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 53 West 23rd street, 6th floor, New York, NY USA
| | - Ericka Fong
- Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 53 West 23rd street, 6th floor, New York, NY USA
| | - Jennifer I. Lee
- Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 53 West 23rd street, 6th floor, New York, NY USA
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COVID-19, Race/Ethnicity, and Age: the Role of Telemedicine to Close the Gaps on Health Disparities. JOURNAL OF ECONOMICS, RACE, AND POLICY 2021; 5:241-251. [PMID: 35300311 PMCID: PMC8390063 DOI: 10.1007/s41996-021-00089-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 11/16/2022]
Abstract
The novel COVID-19 outbreak is a major public health challenge that quickly turned into an economic recession of great proportions. This pandemic poses a trade-off between health and the economy where social distancing, quarantines, and isolation shut down demand and supply chains across the USA. This paper analyzes the impact of COVID-19 on illness and death among older adults and communities of color with low socioeconomic status in New York City. To achieve this goal, fractional logit models are used to capture changes in the novel virus’ morbidity and mortality rates at the neighborhood level. Median income, race/ethnicity, age, household crowding, and socially interactive employment explained the disproportionate exposure and fatalities across the city. We also employ a variable related to telehealth/telemedicine to sustain that technology goods along with government intervention as a provider of social goods can ameliorate existing health disparities. There is a need for evidence-based data on the economic costs and social benefits of COVID-19 relief programs.
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Shanbehzadeh M, Kazemi-Arpanahi H, Kalkhajeh SG, Basati G. Systematic review on telemedicine platforms in lockdown periods: Lessons learned from the COVID-19 pandemic. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:211. [PMID: 34395648 PMCID: PMC8318195 DOI: 10.4103/jehp.jehp_1419_20] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/21/2020] [Indexed: 05/07/2023]
Abstract
With the onset of the coronavirus disease 2019 (COVID-19) outbreak, the transformation of the care delivery model from conventional in-person (face to face) to largely virtual or remote care has been accelerated to appropriately allocate resources and constrain the spread of the virus. In this regard, telemedicine is a breakthrough technology to battle against the COVID-19 emergency. Therefore, we sought to identify the telemedicine applications in the COVID-19 pandemic (tele-COVID) according to interaction modes, transmission modalities, and disease categories. This systematic review was conducted through searching five databases including PubMed, Scopus, ProQuest, Web of Science, and Science Direct. Inclusion criteria were studies clearly outlining any use of telemedicine interactive mode during the COVID-19 pandemic, written in English language and published in peer-reviewed journals in 2020. Finally, 43 articles met the inclusion out of the 1118 search results. Telemedicine provides a diversity of interaction modes and modalities affordable by patients and physicians including short message service, E-mail and web portals, secure telephone calls or VOIP, video calls, interactive mobile health applications (m-Health), remote patient monitoring, and video conferencing. Transmission of video data using synchronized video calls via common social media had the highest and exchange of data using store-forward service via secure messaging technology and prerecorded multimedia had the lowest popularity for virtual disease management during the COVID-19 outbreak. Selection of telemedicine communication services and interaction modes with regard to its use-case, disease category, and application plays a significant role in the success of remote disease management infrastructures in this scenario and their implication for a better future healthcare system.
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Affiliation(s)
- Mostafa Shanbehzadeh
- Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Hadi Kazemi-Arpanahi
- Department of Heath Information Technology, Abadan University of Medical Sciences, Abadan, Iran
- Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran
| | | | - Gholam Basati
- Department of Biochemistry, School of Medicine Biotechnology and Medicinal Plants Research Center, Ilam University of Medical Sciences, Ilam, Iran
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Gómez AM, Henao D, Parra D, Kerguelen A, Pinilla MV, Muñoz OM, Rondón M. Virtual training on the hybrid close loop system in people with type 1 diabetes (T1D) during the COVID-19 pandemic. Diabetes Metab Syndr 2021; 15:243-247. [PMID: 33450533 PMCID: PMC7785279 DOI: 10.1016/j.dsx.2020.12.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS In Colombia, the government established mandatory isolation after the first case of COVID-19 was reported. As a diabetes care center specialized in technology, we developed a virtual training program for patients with type 1 diabetes (T1D) who were upgrading to hybrid closed loop (HCL) system. The aim of this study is to describe the efficacy and safety outcomes of the virtual training program. METHOD ology: A prospective observational cohort study was performed, including patients with diagnosis of T1D previously treated with multiple doses of insulin (MDI) or sensor augmented pump therapy (SAP) who were updating to HCL system, from March to July 2020. Virtual training and follow-up were done through the Zoom video conferencing application and Medtronic Carelink System version 3.1 software. CGM data were analyzed to compare the time in range (TIR), time below range (TBR) and glycemic variability, during the first two weeks corresponding to manual mode with the final two weeks of follow-up in automatic mode. RESULTS 91 patients were included. Mean TIR achieved with manual mode was 77.3 ± 11.3, increasing to 81.6% ± 7.6 (p < 0.001) after two weeks of auto mode use. A significant reduction in TBR <70 mg/dL (2,7% ± 2,28 vs 1,83% ± 1,67, p < 0,001) and in glycemic variability (% coefficient of variation 32.4 vs 29.7, p < 0.001) was evident, independently of baseline therapy. CONCLUSION HCL systems allows T1D patients to improve TIR, TBR and glycemic variability independently of previous treatment. Virtual training can be used during situations that limit the access of patients to follow-up centers.
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Affiliation(s)
- Ana M Gómez
- Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Endocrinology Unit, Bogotá, Colombia.
| | - Diana Henao
- Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Endocrinology Unit, Bogotá, Colombia.
| | - Darío Parra
- Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Endocrinology Unit, Bogotá, Colombia.
| | - Alfonso Kerguelen
- Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Endocrinology Unit, Bogotá, Colombia.
| | | | - Oscar Mauricio Muñoz
- Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Department of Internal Medicine, Bogotá, Colombia.
| | - Martin Rondón
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia.
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Virtual Urgent Care Quality and Safety in the Time of Coronavirus. Jt Comm J Qual Patient Saf 2020; 47:86-98. [PMID: 33358323 PMCID: PMC7566682 DOI: 10.1016/j.jcjq.2020.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 12/22/2022]
Abstract
Background Telemedicine use rapidly increased during the COVID-19 pandemic. This study assessed quality aspects of rapid expansion of a virtual urgent care (VUC) telehealth system and the effects of a secondary telephonic screening initiative during the pandemic. Methods A retrospective cohort analysis was performed in a single health care network of VUC patients from March 1, 2020, through April 20, 2020. Researchers abstracted demographic data, comorbidities, VUC return visits, emergency department (ED) referrals and ED visits, dispositions, intubations, and deaths. The team also reviewed incomplete visits. For comparison, the study evaluated outcomes of non-admission dispositions from the ED: return visits with and without admission and deaths. We separately analyzed the effects of enhanced callback system targeting higher-risk patients with COVID-like illness during the last two weeks of the study period. Results A total of 18,278 unique adult patients completed 22,413 VUC visits. Separately, 718 patient-scheduled visits were incomplete; the majority were no-shows. The study found that 50.9% of all patients and 74.1% of patients aged 60 years or older had comorbidities. Of VUC visits, 6.8% had a subsequent VUC encounter within 72 hours; 1.8% had a subsequent ED visit. Of patients with enhanced follow-up, 4.3% were referred for ED evaluation. Mortality was 0.20% overall; 0.21% initially and 0.16% with enhanced follow-up (p = 0.59). Males and black patients were significantly overrepresented in decedents. Conclusion Appropriately deployed VUC services can provide a pragmatic strategy to care for large numbers of patients. Ongoing surveillance of operational, technical, and clinical factors is critical for patient quality and safety with this modality.
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