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Nakamoto CH, Cutler DM, Beaulieu ND, Uscher-Pines L, Mehrotra A. The Impact Of Telemedicine On Medicare Utilization, Spending, And Quality, 2019-22. Health Aff (Millwood) 2024; 43:691-700. [PMID: 38630943 DOI: 10.1377/hlthaff.2023.01142] [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] [Indexed: 04/19/2024]
Abstract
Telemedicine use remains substantially higher than it was before the COVID-19 pandemic, although it has fallen from pandemic highs. To inform the ongoing debate about whether to continue payment for telemedicine visits, we estimated the association of greater telemedicine use across health systems with utilization, spending, and quality. In 2020, Medicare patients receiving care at health systems in the highest quartile of telemedicine use had 2.5 telemedicine visits per person (26.8 percent of visits) compared with 0.7 telemedicine visits per person (9.5 percent of visits) in the lowest quartile of telemedicine use. In 2021-22, relative to those in the lowest quartile, Medicare patients of health systems in the highest quartile had an increase of 0.21 total outpatient visits (telemedicine and in-person) per patient per year (2.2 percent relative increase), a decrease of 14.4 annual non-COVID-19 emergency department visits per 1,000 patients per year (2.7 percent relative decrease), a $248 increase in per patient per year spending (1.6 percent relative increase), and increased adherence for metformin and statins. There were no clear differential changes in hospitalizations or receipt of preventive care.
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Affiliation(s)
| | - David M Cutler
- David M. Cutler, Harvard University and National Bureau of Economic Research, Cambridge, Massachusetts
| | | | | | - Ateev Mehrotra
- Ateev Mehrotra , Harvard University and Beth Israel Deaconess Medical Center, Boston, Massachusetts
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2
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Tilhou AS, Dague L, Chachlani P, Burns M. Can telehealth expansion boost health care utilization specifically for patients with substance use disorders relative to patients with other types of chronic disease? PLoS One 2024; 19:e0299397. [PMID: 38557607 PMCID: PMC10984462 DOI: 10.1371/journal.pone.0299397] [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: 04/25/2023] [Accepted: 02/08/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Patients with substance use disorders (SUDs) exhibit low healthcare utilization despite high risk of poor outcomes. Telehealth expansion may boost utilization, but it is unclear whether telehealth can increase utilization for patients with SUDs beyond that expected for other chronic diseases amenable to remote treatment, like type 2 diabetes. This information is needed by health systems striving to improve SUD outcomes, specifically. This study compared the impact of telehealth expansion during the COVID-19 public health emergency (PHE) on utilization for patients with SUDs and diabetes. METHODS Using Wisconsin Medicaid administrative, enrollment and claims data 12/1/2018-12/31/2020, this cohort study included nonpregnant, nondisabled adults 19-64 years with SUDs (N = 17,336) or diabetes (N = 8,499). Outcomes included having a primary care visit in the week (any, and telehealth) for any diagnosis, or a SUD or diabetes diagnosis; and the weekly fraction of visits completed by telehealth. Logistic and fractional regression examined outcomes pre- and post-PHE. Covariates included age, sex, race, ethnicity, income, geography, and comorbid medical and psychotic disorders. RESULTS Post-PHE, patients with SUDs exhibited greater likelihood of telehealth utilization (percentage point difference (PPD) per person-week: 0.2; 95% CI: 0.001-0.003; p<0.001) and greater fractional telehealth use (PPD: 1.8; 95%CI: 0.002-0.033; p = 0.025) than patients with diabetes despite a larger overall drop in visits (PPD: -0.5; 95%CI: -0.007- -0.003; p<0.001). CONCLUSIONS Following telehealth expansion, patients with SUDs exhibited greater likelihood of telehealth utilization than patients with diabetes. This advantage lessened the substantial PHE-induced healthcare disruption experienced by patients with SUDs. Telehealth may boost utilization for patients with SUDs.
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Affiliation(s)
- Alyssa Shell Tilhou
- Department of Family Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA, United States of America
| | - Laura Dague
- Public Service & Administration, Texas A&M University, College Station, TX, United States of America
| | - Preeti Chachlani
- Institute for Research on Poverty, University of Wisconsin—Madison, Madison, WI, United States of America
| | - Marguerite Burns
- Department of Population Health Sciences, University of Wisconsin—Madison, Madison, WI, United States of America
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3
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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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4
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Lee SR, Maxi A, Kim L, Kim Y, Choe I, Hong C, Kim P, Reed PS, Kim Y, Shen J, Yoo JW. Enhancing Telehealth Accessibility for Older Adults in Underserved Areas: A 4M Framework Approach. Gerontol Geriatr Med 2024; 10:23337214241277045. [PMID: 39286401 PMCID: PMC11403561 DOI: 10.1177/23337214241277045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/01/2024] [Accepted: 08/06/2024] [Indexed: 09/19/2024] Open
Abstract
Background: Telehealth has emerged as a vital alternative to traditional healthcare delivery, particularly for rural and underserved populations. While efforts to enhance telehealth accessibility have primarily focused on technological solutions, the effectiveness of its telehealth and the role of physician training in bridging racial and ethnic disparities in telehealth usage remains underexplored. This study evaluates the impact of a trained-physician-delivered, age-friendly telehealth model on healthcare accessibility and outcomes. Methods: A retrospective analysis was conducted on 214 older patients (60+) at an urban primary care facility in Nevada, USA. Patients received telehealth services from either trained or non-trained physicians, with the trained group utilizing a 4M-based telehealth model focusing on Medication, Mentation, Mobility, and What Matters. Results: Findings revealed lower exposure to both general and 4M-based telehealth among Hispanic and Asian patients compared to their white counterparts. Telehealth usage did not significantly reduce hospital or emergency department visits overall. However, certain types of 4M-based telehealth, such as What Matters and Medications, reduced hospital and ED visits. Implications: The development and implementation of telehealth education curricula for healthcare providers could make telehealth more accessible to minority patients, potentially reducing unnecessary emergency department visits and addressing disparities in telehealth access.
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Affiliation(s)
| | - Andrea Maxi
- Wurzweiler School of Social Work, Yeshiva University, New York, NY, USA
| | - Laurie Kim
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
| | | | - Ian Choe
- Telehealth Division, Optum Care Nevada, Las Vegas, USA
| | | | - Pearl Kim
- University of Nevada, Las Vegas, USA
| | | | - Yonsu Kim
- University of Nevada, Las Vegas, USA
| | - Jay Shen
- University of Nevada, Las Vegas, USA
| | - Ji Won Yoo
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
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5
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Shi J, Ye M, Chen H, Lu Y, Tan Z, Fan Z, Zhao J. Enhancing efficiency and capacity of telehealth services with intelligent triage: a bidirectional LSTM neural network model employing character embedding. BMC Med Inform Decis Mak 2023; 23:269. [PMID: 37990204 PMCID: PMC10664586 DOI: 10.1186/s12911-023-02367-1] [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] [Received: 10/26/2022] [Accepted: 11/03/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The widespread adoption of telehealth services necessitates accurate online department selection based on patient medical records, a task requiring significant medical knowledge. Incorrect triage results in considerable time wastage for both patients and medical professionals. To address this, we propose an intelligent triage model based on a Bidirectional Long Short-Term Memory (Bi-LSTM) neural network with character embedding to enhance the efficiency and capacity of telehealth services. METHODS We gathered a 1.3 GB medical dataset comprising 200,000 records, each including medical history, physical examination data, and other pertinent information found on the electronic medical record homepage. Following data preprocessing, a clinical corpus was established to train character embeddings with a medical context. These character embeddings were then utilized to extract features from patient chief complaints, and a 2-layer Bi-LSTM neural network was trained to categorize these complaints, enabling intelligent triage for telehealth services. RESULTS 60,000 chief complaint-department data pairs were extracted from clinical corpus and divided into the training, validation, and test sets of 42,000, 9,000, and 9,000, respectively. The character embedding based Bi-LSTM neural network achieved a macro-precision of 85.50% and an F1 score of 85.45%. CONCLUSION The telehealth triage model developed in this study demonstrates strong implementation outcomes and significantly improves the efficiency and capacity of telehealth services. Character embedding outperforms word embedding, and future work will incorporate additional features such as patient age and gender into the chief complaint feature to future enhance model performance.
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Affiliation(s)
- Jinming Shi
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, No.1 East Jianshe Road, Erqi District, Zhengzhou, Henan, 450052, China
| | - Ming Ye
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, No.1 East Jianshe Road, Erqi District, Zhengzhou, Henan, 450052, China
| | - Haotian Chen
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaoen Lu
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhongke Tan
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, No.1 East Jianshe Road, Erqi District, Zhengzhou, Henan, 450052, China
| | - Zhaohan Fan
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, No.1 East Jianshe Road, Erqi District, Zhengzhou, Henan, 450052, China
| | - Jie Zhao
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, No.1 East Jianshe Road, Erqi District, Zhengzhou, Henan, 450052, China.
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6
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Chu D, Pandit K, Giles R, Olsen E, Fortenko A, Greenwald P, Murano T, Shah K, Lin S. The Utility of a Virtual Emergency Medicine Elective for Visiting Medical Students. Cureus 2023; 15:e43686. [PMID: 37724195 PMCID: PMC10505271 DOI: 10.7759/cureus.43686] [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: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Background Away rotations allow emergency medicine (EM)-bound fourth-year medical students to experience a residency program's educational culture and influence the ranking of residency programs. The financial cost and geographic distance have limited student participation in away electives. In recent years, COVID-19 pandemic-related restrictions on away rotations resulted in the creation of multiple virtual courses. Despite the lifting of restrictions, these courses may still have utility in helping students circumvent barriers to away rotations. Limitations of previously described courses include insufficient student-faculty interaction, which influences students' understanding of the educational environment. We sought to develop and evaluate a virtual EM elective for fourth-year medical students, focused on student-faculty interaction including precepted patient contact. Methodology We developed a two-week virtual EM elective for fourth-year medical students incorporating teaching sessions designed to optimize student-faculty interactions and attending-supervised telemedicine visits. After completion of the course, students completed an anonymous course evaluation. Results Course evaluations showed that the course improved students' understanding of our residency's educational environment by providing students with access to our residency program. The most frequently cited factors preventing participation in a traditional away elective were financial cost, limit in the allowed number of away rotations, and challenges in finding housing. Conclusions We believe this course may be an effective way of improving visiting students' understanding of the educational culture of our EM residency program. Thus, although pandemic-related restrictions have been lifted, this course may serve as a valuable adjunct to the traditional away EM rotation.
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Affiliation(s)
- David Chu
- Emergency Medicine, Massachusetts General Hospital, Boston, USA
| | - Kiran Pandit
- Emergency Medicine, Albert Einstein College of Medicine, New York, USA
| | - Robert Giles
- Emergency Medicine, Memorial Satilla Health, Waycross, USA
| | - Erica Olsen
- Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, USA
| | | | | | - Tiffany Murano
- Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, USA
| | - Kaushal Shah
- Emergency Medicine, Weill Cornell, New York, USA
| | - Sophia Lin
- Emergency Medicine, Weill Cornell, New York, USA
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7
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Nakamoto CH, Wilcock AD, Schwamm LH, Zachrison KS, Uscher-Pines L, Mehrotra A. Variation in patterns of telestroke usage during the COVID-19 pandemic. J Stroke Cerebrovasc Dis 2023; 32:107036. [PMID: 36791674 PMCID: PMC9899774 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107036] [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: 10/28/2022] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVES Early in the pandemic, there was a substantial increase in telestroke uptake among hospitals. The motivations for using telestroke during the pandemic might have been different than for hospitals that adopted telestroke previously. We compared stroke care at hospitals that adopted telestroke prior to the pandemic to care at hospitals that adopted telestroke during the pandemic. MATERIALS AND METHODS Stroke episodes and telestroke use were identified in Medicare Fee-for-Service Data. Hospital and episode characteristics were compared between pre-pandemic (Jan. 2019-Mar. 2020) and pandemic (Apr. 2020-Dec. 2020) adopters. RESULTS Hospital bed counts, critical access statuses, stroke volumes, clinical operating margins, shares of stroke care via telestroke, and vascular neurology consult rates did not differ significantly between pre-pandemic and pandemic-adopting hospitals. Hospitals that never adopted telestroke during the study period were more likely to be small critical access hospitals with low clinical operating margins. CONCLUSIONS Compared to hospitals that adopted telestroke before the pandemic, hospitals that adopted telestroke during the pandemic were similar in characteristics and how they used telestroke.
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Affiliation(s)
- Carter H. Nakamoto
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | | | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | | | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States; Beth Israel Deaconess Medical Center, Boston, MA, United States.
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8
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Li KY, Kim PS, Thariath J, Wong ES, Barkham J, Kocher KE. Standard nurse phone triage versus tele-emergency care pilot on Veteran use of in-person acute care: An instrumental variable analysis. Acad Emerg Med 2023; 30:310-320. [PMID: 36757685 PMCID: PMC10162445 DOI: 10.1111/acem.14681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVES Use of acute care telemedicine is growing, but data on quality, utilization, and cost are limited. We evaluated a Veterans Affairs (VA) tele-emergency care (tele-EC) pilot aimed at reducing reliance on out-of-network (OON) emergency department (ED) care, a growing portion of VA spending. With this service, an emergency physician virtually evaluated selected Veterans calling a nurse triage line. METHODS Calls to the triage line occurring January-December 2021 and advised to seek care acutely within 24 h were included. We described tele-EC user characteristics, common triage complaints, and patterns in referral to and management by tele-EC. The primary outcome was acute care visits (ED, urgent care, and hospitalizations at VA and OON sites) within 7 days of the index call. Secondary outcomes included mortality, OON acute care spending, and the effect of tele-EC visit modality (phone vs. video). We used both standard regression and instrumental variable (IV) analysis, using the tele-EC physician schedule as the instrument. RESULTS Of 7845 eligible calls, 15.5% had a tele-EC visit, with case resolution documented in 57%. Compared to standard nurse triage, tele-EC users were less likely to be Black, had more prior ED visits, and were triaged as higher acuity. Calls concerning dizziness/syncope, blood in stool, and chest pain were most likely to have a tele-EC visit. Tele-EC was associated with fewer ED visits than standard nurse triage in both regression (average marginal effect [AME] -16.8%, 95% confidence interval [CI] -19.2 to -14.4) and IV analyses (AME -17.5%, 95% CI -25.1 to -9.8), lower hospitalization rate (AME -3.1%, 95% CI -6.2 to -0.0), and lower OON spending (AME -$248, 95% CI -$458 to -$38). CONCLUSIONS Among Veterans initially advised to seek care within 24 h, use of tele-EC compared to standard phone triage led to decreased ED visits, hospitalizations, and OON spending within 7 days.
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Affiliation(s)
- Kathleen Y Li
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA.,Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paul S Kim
- VA Ann Arbor Healthcare System, Michigan, Ann Arbor, USA.,Division of Hospital Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Joshua Thariath
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Edwin S Wong
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA.,VA Puget Sound Health Care System, Seattle, Washington, USA
| | | | - Keith E Kocher
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA.,VA Ann Arbor Healthcare System, Michigan, Ann Arbor, USA.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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9
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Jung OS, Graetz I, Dorner SC, Hayden EM. Implementing a COVID-19 Virtual Observation Unit in Emergency Medicine: Frontline Clinician and Staff Experiences. Med Care Res Rev 2023; 80:79-91. [PMID: 35815570 PMCID: PMC9806199 DOI: 10.1177/10775587221108750] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The COVID-19 pandemic pushed hospitals to deliver care outside of their four walls. To successfully scale virtual care delivery, it is important to understand how its implementation affects frontline workers, including their teamwork and patient-provider interactions. We conducted in-depth interviews of 17 clinicians and staff involved with the COVID-19 Virtual Observation Unit (CVOU) in the emergency department (ED) of an academic hospital. The program leveraged remote patient monitoring and mobile integrated health care. In the CVOU (vs. the ED), participants observed increases in interactions among clinicians and staff, patient participation in care delivery, attention to nonmedical factors, and involvement of coordinators and paramedics in patient care. These changes were associated with unintended, positive consequences for staff, namely, feeling heard, experience of meaningfulness, and positive attitudes toward virtual care. This study advances research on reconfiguration of roles following implementation of new practices using digital tools, virtual work interactions, and at-home care delivery.
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Affiliation(s)
- Olivia S. Jung
- Emory University, Atlanta, GA,
USA,Harvard University, Cambridge, MA,
USA,Massachusetts General Hospital, Boston,
USA,Olivia S. Jung, Department of Health Policy
and Management, Rollins School of Public Health, Emory University, 1518 Clifton
Road, Atlanta, GA 30322, USA.
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10
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Stamenova V, Chu C, Borgundvaag E, Fleury C, Brual J, Bhattacharyya O, Tadrous M. Virtual care use prior to emergency department admissions during a stable COVID-19 period in Ontario, Canada. PLoS One 2023; 18:e0277065. [PMID: 37115759 PMCID: PMC10146565 DOI: 10.1371/journal.pone.0277065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The increased use of telemedicine to provide virtual outpatient visits during the pandemic has led to concerns about potential increased emergency department (ED) admissions and outpatient service use prior to such admissions. We examined the frequency of virtual visits use prior to ED admissions and characterized the patients with prior virtual visit use and the physicians who provided these outpatient visits. METHODS We conducted a retrospective, population-based, cross-sectional analysis using linked health administrative data in Ontario, Canada to identify patients who had an ED admission between July 1 and September 30, 2021 and patients with an ED admissions during the same period in 2019. We grouped patients based on their use of outpatient services in the 7 days prior to admission and reported their sociodemographic characteristics and healthcare utilization. RESULTS There were 1,080,334 ED admissions in 2021 vs. 1,113,230 in 2019. In 2021, 74% of these admissions had no prior outpatient visits (virtual or in-person) within 7 days of admission, compared to 75% in 2019. Only 3% of ED admissions had both virtual and in-person visits in the 7 days prior to ED admission. Patients with prior virtual care use were more likely to be hospitalized than those without any outpatient care (13% vs 7.7.%). INTERPRETATION The net amount of ED admissions and outpatient care prior to admission remained the same over a period of the COVID-19 pandemic when cases were relatively stable. Virtual care seemed to be able to appropriately triage patients to the ED and virtual visits replaced in-person visits ahead of ED admissions, as opposed to being additive.
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Affiliation(s)
- Vess Stamenova
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Cherry Chu
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Cathleen Fleury
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Janette Brual
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Onil Bhattacharyya
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mina Tadrous
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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11
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Whitehead DC, Jaffe T, Hayden E, Zachrison KS. Qualitative Evaluation of Quality Measurement Within Emergency Clinician–staffed Telehealth Programs. Ann Emerg Med 2022; 80:401-407. [DOI: 10.1016/j.annemergmed.2022.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/05/2022] [Accepted: 05/23/2022] [Indexed: 01/05/2023]
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12
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Witkowska-Zimny M, Nieradko-Iwanicka B. Telemedicine in Emergency Medicine in the COVID-19 Pandemic-Experiences and Prospects-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8216. [PMID: 35805873 PMCID: PMC9266315 DOI: 10.3390/ijerph19138216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 02/06/2023]
Abstract
Even before the year 2020, telemedicine has been proven to contribute to the efficacy of healthcare systems, for example in remote locations or in primary care. However, with the outbreak of the COVID-19 pandemic, telehealth solutions have emerged as a key component in patient healthcare delivery and they have been widely used in emergency medicine ever since. The pandemic has led to a growth in the number of telehealth applications and improved quality of already available telemedicine solutions. The implementation of telemedicine, especially in emergency departments (EDs), has helped to prevent the spread of COVID-19 and protect healthcare workers. This narrative review focuses on the most important innovative solutions in emergency care delivery during the COVID-19 pandemic. It outlines main categories of active telehealth use in daily practice of dealing with COVID-19 patients currently, and in the future. Furthermore, it discusses benefits as well as limitations of telemedicine.
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Affiliation(s)
| | - Barbara Nieradko-Iwanicka
- Chair and Department of Hygiene and Epidemiology, Medical University of Lublin, 7 Chodzki Str., 20-093 Lublin, Poland;
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13
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Ostberg N, Ip W, Brown I, Li R. Impact of telemedicine on clinical practice patterns for patients with chest pain in the emergency department. Int J Med Inform 2022; 161:104726. [PMID: 35228006 PMCID: PMC8864961 DOI: 10.1016/j.ijmedinf.2022.104726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
Background The outbreak of the COVID-19 pandemic has led to the rapid adoption of novel telemedicine programs within the emergency department (ED) to minimize provider exposure and conserve personal protective equipment (PPE). In this study, we sought to assess how the adoption of telemedicine in the ED impacted clinical order patterns for patients with chest pain. We hypothesize that clinicians would rely more on imaging and laboratory workup for patients receiving telemedicine due to limitation in physical exams. Methods A single-center, retrospective, propensity score matched study was designed for patients presenting with chest pain at an ED. The study period was defined between April 1st, 2020 and September 30th, 2020. The frequency of the most frequent lab, imaging, and medication orders were compared. In addition, poisson regression analysis was performed to compare the overall number of orders between the two groups. Results 455 patients with chest pain who received telemedicine were matched to 455 similar patients without telemedicine with standardized mean difference < 0.1 for all matched covariates. The proportion of frequent lab, imaging, and medication orders were similar between the two groups. However, telemedicine patients received more orders overall (RR, 1.19, 95% CI, 1.11, 1.28, p-value < 0.001) as well as more imaging, lab, and nursing orders. The number of medication orders between the two groups remained similar. Conclusions Frequent labs, imaging, and medications were ordered in similar proportions between the two cohorts. However, telemedicine patients had more orders placed overall. This study is an important objective assessment of the impact that telemedicine has upon clinical practice patterns and can guide future telemedicine implementation after the COVID-19 pandemic.
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