ATA2022 Annual Conference & Expo May 1–3, 2022Boston, Massachusetts
Jointly Provided by the University of Virginia School of Medicine, School of Nursing and American Telemedicine Association
Accreditation & Designation Statement
“In support of improving patient care, this activity has been planned and implemented by the American Telemedicine Association (ATA) and the University of Virginia School of Medicine and School of Nursing is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.”
AMA PRA CATEGORY 1 CREDIT
The University of Virginia School of Medicine and School of Nursing designates this live virtual activity and enduring material, for a maximum of 8AMA PRA Category 1 Credits.™ Physicians should claim only the credit commensurate with the extent of their participation in the activity.
ANCC CONTACT HOURS
The University of Virginia School of Medicine and School of Nursing awards 8 contact hours for nurses who participate in this educational activity and complete the post activity evaluation.
MOC II
Successful completion of this CME activity enables the participant to earn MOC points equivalent to the amount of CME credits claimed for the activity for a maximum of 8.0 MOC Part II (ABMS) points.
“Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 8.0 MOC points [and patient safety MOC credit] in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit”.
Oral Presentations
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2. ASSESSING THE EFFECT OF PAYMENT PARITY ON TELEHEALTH USAGE AT COMMUNITY HEALTH CENTERS DURING COVID‐19
Jordan Herring
Fitzhugh Mullan Institute for Health Workforce Equity
Description: Monthly visit volumes for in‐person and telehealth visits are based on aggregated, de‐identified claims data from FAIR Health that are representative of community health center sites, and this is matched with state‐level designations of payment parity policies. Relationship between telehealth utilization and policy is studied.
Abstract: The COVID‐19 pandemic presented health care providers the incentive to aggressively adopt telehealth usage to supplement their visit levels while minimizing in‐person contact. States quickly altered telehealth coverage and payment policies to ensure ongoing access to care and help prevent spread of the virus. This study examines the effect payment parity had on the likelihood community health centers (CHCs) offered telehealth services in the initial year of the pandemic. The main data source was aggregated, deidentified FAIR Health data on monthly CHC site level visit counts (in‐person and telehealth) for privately insured patients covering dates of service from March 2019 through June 2021. We conducted separate logistic regression models to predict whether CHC sites utilized telehealth during the same four‐month period (March through June) for 1) one year before the pandemic, 2) the immediate pandemic response, and 3) one year after the pandemic.
Classification of Research: Regulatory & Policy Research
Results: Use of telehealth by CHC sites for privately insured patients surged during the immediate four‐month period of the pandemic to approximately 61%, but tapered off to approximately 44% one year later. Parity of payment was associated with greater likelihood of using telehealth beyond the initial four‐month period of the pandemic (OR:1.762, p < 0.001). Additionally, greater broadband access was positively associated with telehealth usage while rurality of the CHC site locations was negatively associated.
Conclusions: Paying the same amount for telehealth visits as in‐person visits appears to make telehealth a more sustainable option in community health centers. Investments in broadband infrastructure could also help increase use of telehealth, particularly in rural areas.
3. ASSESSMENT OF PROVIDER DIAGNOSTIC ACCURACY WITH VIDEO TELEMEDICINE IN THE INTEGRATED MULTISPECIALTY PRACTICE AT MAYO CLINIC DURING THE COVID‐19 PANDEMIC
Bart Demaerschalk, MD, Andrew Pines, Richard Butterfield, Jack Haglin, Tufia Haddad, James Yiannias, Christopher Colby, Sarvam TerKonda, Steve Ommen, Matthew Bushman, Troy Lokken, R Blegen, Mekenzie Hoff, Gregory Anthony, Jordan Coffey, Nan Zhang
Diagnostic Accuracy of Telemedicine Utilized at Mayo Clinic Alix School of Medicine Study Group
Description: There was a shift in patient volume from in‐person to video telemedicine visits during the COVID‐19 pandemic. Objective of this study was to determine the accuracy of provisional diagnoses established at a video telemedicine visit for patients presenting with a new clinical problem.
Abstract: Design: Retrospective review of patients who underwent a video telemedicine consult followed by an in‐person outpatient visit for the same clinical problem in the same specialty within a 90‐day window. The provisional diagnosis made during the video telemedicine visit was compared to the reference standard diagnosis by two blinded, independent medical reviewers. A multivariate logistic regression model was used to determine factors significantly related to diagnostic accuracy.
Setting: Mayo Clinic, U.S.A., a large academic integrated multi‐specialty healthcare institution, between March 24 and June 24, 2020
Participants: Mayo Clinic patients residing in the U.S.A. without age restriction
Exposure: New clinical problem assessed via video telemedicine visit to home utilizing Zoom Care Anyplace integrated into Epic
Main Outcome: Accuracy of provisional diagnoses established over video telemedicine visits compared against a reference standard diagnosis
Method: Observational
Classification of Research: Access to Care
Results: There were 2393 subjects in the analysis. The median age of patients was 53 years, and 1381/2393 (57.7%) identified as female and 1012/2393 (42.3%) identified as male. Overall, the provisional diagnosis established over video telemedicine visit matched the in‐person reference standard diagnosis in 2080/2393 [86.9% (95% CI 85.6%‐88.3%)] of cases. Diagnostic accuracy by ICD 10 chapter ranged from 65% (95% CI 42%‐87%) for “Diseases of the Ear and Mastoid Process” to 97% (95% CI 95%‐99%) for “Neoplasms”. Diagnostic accuracy by medical specialty ranged from 77% (95% CI 65%‐90%) for Otorhinolaryngology to 96% (92%‐100%) for Psychiatry. Specialty care was found to be significantly more likely than primary care to result in video telemedicine diagnoses congruent with a subsequent in‐person visit (OR:1.69; 95% CI: 1.24, 2.30. p < .001).
Conclusions: Video telemedicine visits yield a high degree of diagnostic accuracy for most new clinical concerns, although it is important to recognize when specific clinical circumstances may be associated with decreased diagnostic accuracy over video telemedicine and which patients may benefit from timely in‐person follow up.!Video telemedicine visits yield a high degree of diagnostic accuracy for most new clinical concerns, although it is important to recognize when specific clinical circumstances may be associated with decreased diagnostic accuracy over video telemedicine and which patients may benefit from timely in‐person follow up.
4. ENDING INEQUITY IN HEALTHCARE ACCESS: A TELEHEALTH PRIORITY
Cynthia Williams
University of North Florida
Description: Access to care was critical during COVID19 and will continue to be an integral part of healthcare delivery. This research study provides insight to mitigate inequity in healthcare access by examining inequities in access and recommending strategies to increase access to vulnerable groups.
Abstract: The global COVID‐19 pandemic has propelled the use of technology for healthcare services delivery. Through legislative measures and reimbursement practices, we witnessed overwhelming support for telehealth services to facilitate access to care during COVID‐19. However, the support and use for telehealth services must accompany outcomes that contribute to equity in access. If today’s society is to support public health and healthcare, equal access to telehealth resources must be a priority. To achieve health equity, technology‐based resources should be comprehensively addressed to ensure that all racial/ethnic groups have access to all platforms for care. The study objective is to examine the use of telehealth services among racial/ethnic minority groups before and during the pandemic. The COVID‐19 Research Database Consortium provided data for this study. The study period was March 2019 to December 2019 and March 2020 to December 2020. Electronic health records of patients in the Healthjump database were examined. We performed a retrospective study on three racial/ethnic groups: non‐Hispanic Whites, non‐Hispanic Blacks Americans, and Hispanics. We used Logistic Regression to examine the study objective.
Method: Descriptive
Classification of Research: Access to Care
Results: We examined 17.98 million unique visit records from March 2019 to December 2019 and 22.17 million records of March 2020 to December 2020 to investigate changes in telehealth utilization before and during the pandemic. Pre‐COVID and during COVID telehealth visits accounted for 8.33% and 11.08% of total visits, respectively, with a peak of 15.46% in April 2020. Pre‐COVID, the Hispanic group showed a significantly lower utilization rate (5.36%) than the non‐Hispanic White groups (8.39%, p‐value <0.01) and Blacks (22.11%; p‐value <0.01). During the pandemic, Hispanic Americans (p‐value <0.01) had an adjusted odds ratio of 0.62.
Conclusions: The odds of using telehealth by Hispanic Americans were still significantly lower compared to Whites and Blacks during the pandemic. Despite the removal of regulatory and reimbursement barriers to telehealth, utilization trends were largely unchanged. By identifying subgroups who are not accessing telemedicine, we recommend strategies and policy interventions to educate and target minority groups to promote the use of telemedicine services.
5. ENSURING EQUITY: LESSONS FROM COVID‐19 REMOTE PATIENT MONITORING
Lulu Wang
MedStar Health
Description: Remote patient monitoring (RPM) has evolved into a powerful tool for expanding care delivery. Here, we discuss lessons learned from implementing a large‐scale COVID‐19 RPM program. Which disparities in telehealth access are highlighted with RPM? How can we make RPM more accessible?
Abstract: RPM filled an important care gap during COVID‐19. For some, RPM served as a primary point of access to the health care system. It allowed for early detection of disease progression and provided additional reassurance to patients safely recovering at home. However, RPM remains vulnerable to the same disparities that affect healthcare as a whole: differences in health literacy, technologic literacy, and availability of services. Over the course of 11 months, our hospital system enrolled over 2047 patients in a COVID‐19 RPM program – the largest to‐date to capture both physiologic and symptomatologic data. We included two populations that often experience limited access to RPM: participants without smartphones, and participants whose primary language is not English. These are the exact vulnerable populations for whom RPM may prove particularly valuable as a safety net.
Method: Descriptive
Classification of Research: Access to Care
Results: We referred 4163 patients and enrolled 2047 patients on the RPM platform. Of these, 120 did not own smartphones and 43 spoke a primary language other than English (including Spanish, Portuguese, and Thai). Participants without smartphones required additional time resources; the RPM team called patients individually to collect data, as patients were not able to upload vital signs via the default method (Bluetooth‐enabled pulse oximeter and phone app). For non‐English speaking patients, the app was available in Spanish. Any other communication between the RPM team and participant required the assistance of interpreter services.
Conclusions: RPM has rapidly expanded our scope of clinical care delivery. As its utilization continues to grow, we should be cognizant of promoting equity. Inclusion criteria, platform selection, communication modality, and methods of data collection all significantly impact patient experience. If deployed conscientiously, RPM can be a powerful tool to fill existing holes in health care accessibility.
6. EVALUATION OF THE GREEK NATIONAL TELEMEDICINE NETWORK SERVICES IN THE AEGEAN ARCHIPELAGOS, DURING THE YEARS 2016‐2018
Alexandra Bargiota, Alexandros Sarpakis, Athanasios Argyriadis, Christos Roilos, Eleftherios Thireos, George E. Dafoulas, Georgios Koukoulas, Haralampos Karanikas
University of Thessaly
Description: The Greek Ministry of Health established the National Telemedicine Network (EDIT) in 2016, to cover, in the first stage, 43 sites of the 2nd Regional Health Authority, 30 of them remotely and 13 urban located in islands of Aegean Archipelagos. This study evaluated these services for the years 2016‐2018.
Abstract: The methodology for the evaluation of the EDIT services was based on “The Model for ASsessment of Telemedicine applications (MAST). MAST is a multidisciplinary assessment, for telemedicine services, that comprise seven domains (1. Health problem and characteristics of the application 2. Safety 3. Clinical effectiveness 4. Patient perspectives 5. Economic aspects 6. Organisational aspects 7. Socio‐cultural, ethical and legal aspects), based on the Health Technology Assessment (HTA) domains in the EUnetHTA model. In this study evaluation included the domains 1, 2, 6,7, while the evaluation of domains 3,4, and 5 will be performed per pathology, in other studies. The analysis included qualitative research based on interviews with personnel, health professionals and involved stakeholders, plus quantitative research based on descriptive methodolgy. The evaluation was performed by the University of Thessaly based on the data (years 2016‐2018) that were provided by the 2nd Regional Health Authority. The asynchronous and synchronous telemedicine services of EDIT, include teleconsultations for 25 specialties, emergency telemedicine and tele‐training. The urban located sites also called “doctor’s end‐point”, are equipped with the video conference system and receive the patient’s vital signs measurements. The remote located sites also called “patient’s end‐point”, are additionally equipped with medical devices for the patient’s examination.
Method: Descriptive
Classification of Research: Measurement Frameworks & Tools
Results: The number of tele‐consultations increased gradually per year of service (2016:248, 2017:303, 2018:1205). The majority of tele‐consultations included Telepsychiatry with children (2016:49.19%, 2017:64.68%, 2018:38.75%), Telepsychiatry with adults (2017:13.33%, 2018:33.52%) and Tele‐diabetology (2017:7.2%, 2018:15.51%). No safety incidences were reported and based on the Service‐Level Agreement all technical problems were solved within the agreed mean time between failures (MTBF) and the mean time to repair or mean time to recovery (MTTR). Legal framework for telemedicine services in Greece is based on law 66§16‐3984/2011, and Data Protection and Privacy on the European General Data Protection Directive (GDPR).
Conclusions: The introduction of telemedicine services of EDIT was mostly deployed in the clinical pathologies that adopted a specific tele‐consultation clinical protocol. The deployment of telemedicine services of EDIT were not followed by organisational changes, including the referral procedures that did not include prior requests for tele‐consultation and no reimbursement has been introduced. Safety and Data Privacy issues were managed adequately.
Acknowledgement: This research has been co‐financed by the European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the call RESEARCH – CREATE – INNOVATE (project code: Τ2EDK‐00640).”
7. FROM DISEASE‐CENTRIC TO HUMAN‐CENTRIC REMOTE PATIENT MONITORING: WHAT IS THE ROLE OF DATA QUALITY MANAGEMENT?
Robab Abdolkhani
RMIT University
Description: The use of various technologies in disconnected remote patient monitoring programs which capture a large volume of data in multiple formats and inconsistent ways under the patient’ or carer’s supervision outside the clinical environment significantly impact the quality of data. Best practice recommendations were developed to address this issue.
Abstract: Remote Patient Monitoring (RPM) is a complex system of people, processes, and technologies that constantly interact to monitor various health conditions and provide a comprehensive picture of the patient’s status. However, current RPM programs are not integrated; instead, each RPM is used for one health condition and captures data relevant to that condition. This approach is not responsive to the needs of people suffering from multimorbidity to provide holistic patient‐centred care. The result is that a patient might participate in multiple RPM programs and use various disconnected technologies and platforms that capture a large volume of data in various formats and inconsistent ways, which significantly impact the quality of data, especially that data are collected under the patient’ or carer’s supervision outside the clinical environment.
This issue was addressed via PhD research that provided innovative best practice recommendations for data quality management in RPM programs. The developed and validated recommendations comprising 19 items across seven aspects of data quality: accessibility, accuracy, completeness, consistency, interpretability, relevancy, and timeliness. It aims to drive strategies to collect and manage high‐quality data to integrate data with confidence from different RPM programs, improve multimorbidity monitoring, and provide efficient patient‐centred care.
Method: Survey/Qualitative
Classification of Research: Quality Improvement
Results: A DQM guideline was developed via five qualitative studies. Stakeholders with experience in RPM were involved in interviews to identify DQM challenges and a workshop to co‐design solutions. The findings along with results from literature and policy review were interpreted to construct the guideline. It comprised 19 recommendations across PGHD accessibility, accuracy, completeness, consistency, interpretability, relevancy, and timeliness. It was then validated by international health informatics and health information management experts on its likely contribution to the safety and quality of care in RPM which gained consensus that the recommendations are essential to delivering safe and high‐quality RPM.
Conclusions: The increasing proliferation of PGHD from health wearables in RPM requires a systematic approach to enable the reliability of these data for use in patient‐centred care.
These best practices provide new insights on PGHD quality management as these data are collected outside the healthcare setting, and different stakeholders are involved in PGHD management outside the healthcare setting and inside it. Using these recommendations could guide the integration of different RPM and provide comprehensive data quality management practice. Also, they can increase stakeholders’ awareness of PGHD quality and their potential roles and responsibilities to provide high‐quality data.
8. HOW SHOULD WE BE INTERPRETING LANGUAGE IN TELEHEALTH CONSULTATIONS?
S. Chan, MD, MBA; H. Tougas, MD; T. Shahrvini, BS; A. Gonzalez, MA; Reyes R. Chun, BA; Parish M. Burke, PhD; P. Yellowlees, MBBS, MD
UC Davis
Description: Patients with Limited English Proficiency (LEP) frequently receive below standard care because of language communication difficulties. Medical interpreters are often in short supply and tend to lengthen the time and simplify the language of medical interviews. A combination of Automated Speech Recognition (ASR) and Automated Machine Translation (AMT) technologies have been developed as a method of artificial intelligence (AI) interpretation. We have applied these to Asynchronous Telepsychiatry consultations (ATP) as we believe AI‐interpretation may be a way of improving psychiatric interviews across languages compared with interviews mediated through human‐interpretation.
Abstract: AMT and ASR technologies have been used and evaluated for the translation of health education materials and in general medical encounters, however, no known evaluation of mental health interviews exists. We performed two studies to firstly examine differences in patient’s language when using interpreters compared with speaking to a same language interviewer, and then to assess the accuracy of ASR and AMT artificial intelligence translation engines by testing and comparing two major publicly available cloud services.
In study 1 we used three recorded psychiatric interviews performed by bilingual clinician actors to compare the word error rate (WER) the and the accuracy rates of ASR transcript generation and AMT steps between the two translation engines
In study 2, we used a convenience sample of recorded pairs of psychiatric interviews in 3 Spanish speaking patients, both interpreted and ATP, from a group of patients involved in a larger study examining translation and interpretation accuracy and patient preferences. The number of examples of figurative language (such as similes and metaphors), the translation accuracy of the figurative language and the patient word counts were compared, as proxies for interview complexity and volume.
Method: Observational
Classification of Research: Patient Experience
Results: Google Translate was consistently more accurate and had less word errors than Microsoft Translator, and was similar in accuracy to in‐person translation accuracy rates reported in the literature. We found in the AI‐interpretation model that word counts were greater and that figurative language examples were more common but less accurately translated than in the human interpreter model.
Conclusions: These are the first known studies conducted to evaluate human interpreted interviews as compared to the use of AMT and ASR for psychiatric interviews. The use of machine learning transcription and translation systems in psychiatry has great potential but the accuracy of such systems depends on which products are used. According to industry literature, the accuracy appears to be improving over time. The use of human interpreters led patients to simplify and shorten their language, potentially omitting information that would be important in a psychiatric interview. The best long‐term option, as ASR and AMT gradually become more accurate, would appear to be the automated process where patients are interviewed and recorded in their own language prior to AMT and ASR. This would lead to patients providing more detailed, richer and likely more clinically useful histories than with the current gold standard use of human interpreters. This novel approach to clinical interviews should eventually lead to a reduction in the health impact of language disparities in the mental health field.
9. IMPLEMENTATION OF A COLLABORATIVE MODEL OF INTEGRATED MEDICAL AND BEHAVIORAL HEALTHCARE THAT PROVIDES CHRONIC DISEASE MANAGEMENT VIA TELEHEALTH
Brian Clear, Rebekah Rollston, Sarah Howroyd
Bicycle Health
Description: This descriptive study presents a novel model of collaborative, integrated medical and behavioral healthcare that delivers technology‐enabled biopsychosocial treatment of opioid use disorder (OUD) via telehealth. This model has the potential to decrease stigma for persons seeking OUD treatment, as well as increase access to treatment in many geographic areas.
Abstract: In 2020, the opioid epidemic in the United States claimed the lives of 186 people each day, a 26% increase from the year prior. Per 2018 National Survey on Drug Use and Health data, only 19.7% of persons interested in treatment for opioid use disorder (OUD) had actually accessed care through existing systems, while capacity for office‐based opioid treatment remained dramatically underutilized. The approach of training more providers to deliver medication for opioid use disorder (MOUD) through existing systems has not addressed this access gap effectively, and the need for a truly biopsychosocial model of care with a focus on reaching unengaged populations has become increasingly clear. This descriptive study will present a novel clinical model of collaborative, integrated medical and behavioral healthcare that delivers technology‐enabled biopsychosocial treatment of OUD via telehealth. This model of tele‐OUD treatment includes three primary pillars: patient‐centered care, including chronic disease management and behavioral health; creation of tech‐enabled systems and resources; and data‐driven decision‐making. The patient treatment journey will be detailed, which includes development of a personalized treatment plan with an addiction medicine licensed provider, use of the buprenorphine induction tool, pharmacy finder tool, and engagement with the integrated behavioral health team and care coordinators.
Method: Descriptive
Classification of Research: Access to Care
Results: This innovative, biopsychosocial model of tele‐OUD healthcare delivery has served more than 66% of the United States population across 23 states. Analysis of the Brief Addiction Monitor demonstrates decreased opioid use and risk, decreased health services utilization, increased protective factors, and increased quality of life measures among this telehealth patient population, as well as retention rates at 30, 60, and 90 days that are appreciably higher than the industry average.C
Conclusions: This novel clinical model of collaborative, integrated medical and behavioral healthcare that delivers technology‐enabled biopsychosocial treatment of OUD via telehealth has the potential to decrease stigma for persons seeking OUD treatment, as well as increase access to treatment in many geographic areas, with a special emphasis on buprenorphine deserts. This integrated, collaborative, and comprehensive approach can be utilized and adapted by other healthcare service providers to increase access to treatment for persons living with opioid use disorder.
10. IMPLEMENTATION OF A NOVEL TELEHEALTH PATIENT ADVISORY COUNCIL
Alex Lynch‐Coffey, Jennifer Harris, Liza Hoffman, Rafael Caycho, Rebekah Rollston, Wynne Gallogly
Bicycle Health
Description: This implementation study describes the development of a fully telehealth Patient Advisory Council in a healthcare organization that provides biopsychosocial treatment of opioid use disorder via telehealth. The challenges, iterations, and key learnings presented herein may serve as an example for other telehealth Patient Advisory Councils.
Abstract: Patient Advisory Councils have recently become a standard of care within organizations that provide in‐person health services, as patient‐centered systems seek to include the unique and invaluable perspectives of patients in care delivery, quality improvement, and innovation efforts. This implementation study describes the development of a fully telehealth Patient Advisory Council in a healthcare organization that provides biopsychosocial treatment of opioid use disorder via telehealth. We describe challenges, as well as iterations of addressing each challenge, including the following: diverse patient recruitment; understanding of the stigma often attributed to patients with opioid use disorder and how this influences their involvement in healthcare, and advisory councils in particular; advisory council compliance with 42 CFR Part 2 and navigation of this extra consent step with advisory council patients; building trust in a remote environment; patient versus staff participation during meetings; and how to approach quality improvement work in a new Patient Advisory Council.
Method: Implementation Science
Classification of Research: Patient Experience
Results: This fully telehealth Patient Advisory Council includes six patients and six staff members. Patients are diverse in age, gender, geography, and life experiences. Staff are represented from all patient‐facing roles within the healthcare organization. Key learnings address diverse patient recruitment, compliance with 42 CFR Part 2, building trust, developing mission and vision for the advisory council, and implementation of quality improvement work. Qualitative patient feedback regarding the Patient Advisory Council itself is a key result. Next steps include evaluation of quality improvement work and its impact on healthcare delivery and innovation.
Concusions: This fully telehealth Patient Advisory Council is a forum for patients and staff to work together to improve healthcare service delivery, as well as direct community engagement and advocacy, ultimately with the goal to provide more equitable access to treatment for persons living with opioid use disorder. As a fully remote healthcare organization that serves patients living with opioid use disorder, this Patient Advisory Council is a novel concept. The challenges, iterations, and key learnings presented herein may serve as an example for other telehealth Patient Advisory Councils.
11. IMPLEMENTATION OF AN AI‐ENHANCED DIGITAL STETHOSCOPE AT A COMMUNITY VALVULAR HEART DISEASE SCREENING PROGRAM
Leland Pung, Chad Kaplan MD, Brooke Everett RN, Ka Ki Jacqueline Chan, Caroline Currie, Antoine Keller MD
Description: Successful development of telehealth capabilities necessitates the development of AI focused tools to expand clinical decision making, enabling clinicians to scale care and impact more patients. We assessed the implementation of such a tool at a community heart disease screening program.
Abstract: Artificial intelligence (AI/ML) algorithms have been trained to detect valvular heart disease (VHD) with similar proficiency to experienced cardiologists. Use of AI/ML has the potential to enable general clinicians to scale screening for the larger community, potentially expanding the reach of care and improving time to care. Further research is needed, however, to examine the utility of these tools in real world settings and implementation for telehealth. We explored the possibility of using AI/ML to enhance the screening capabilities of medical students and residents in comparison to POCUS examination by fellowship trained cardiologists or cardiac surgeons.
Methods: Patients at a community cardiovascular screening program in the South were screened for valvular heart disease from January 2021 to September 2021. Patients were initially screened by a medical student or resident using an AI/ML‐enhanced digital stethoscope (Eko DUO) before being examined with POCUS (the Butterfly iQ+) by a fellowship trained cardiologist or cardiac surgeon. As an explorative pilot study, the focus was understanding the workflow of AI/ML screening for murmurs and classification of those murmurs.
Method: Observational
Classification of Research: Clinical Outcomes
Results: 302 patients were examined with AI/ML‐enhanced stethoscope and POCUS (193 Females, 86 Males, average age = 69.7). 57 patients had evidence of VHD seen on POCUS, indicating a population prevalence of 18.8% (Aortic Regurgitation n = 5, Aortic Sclerosis n = 19, Aortic Stenosis n = 25, Mitral Regurgitation, n = 6, Mitral Stenosis, n = 5, Tricuspid Regurgitation, n = 1). Of those with VHD on POCUS, the AI identified 31 murmurs (sensitivity = 54.4%, PPV = 63%). 243 patients had no evidence of VHD of which 226 were correctly classified (specificity = 93%, NPV = 89.6%). The AI/ML stethoscope classified 7 murmurs as diastolic, of which 5 had valvular pathology that led to cardiologist referrals.
Conclusions: Initial exploratory results show that implementation of AI/ML‐enhanced digital stethoscopes can enable clinicians to scale cardiac screening. Another phase of this study is needed to evaluate AI/ML screening vs. POCUS utility and accuracy and the performance in a telehealth focused cohort.
12. IMPROVING SPECIALTY CARE ACCESS VIA TELEMEDICINE
Guenevere Burke, Kareem Osman, Lisa Martin, Neal Sikka, Nicole Ehrhardt, Richard Amdur, Susie Lew
George Washington University
Description: We report on the establishment of telemedicine clinics in endocrinology, cardiology and nephrology with an urban underserved clinic as originating site. In this prospective cohort study, telemedicine produced equivalent outcomes in the management of diabetes, hypertension and kidney disease, with high patient satisfaction, promising as a way to improve access.
Abstract: Objective: To develop and evaluate a hybrid care model for specialty telemedicine for urban underserved patients.
Setting: This study was conducted at a Federally Qualified Health Center (FQHC) and an academic medical center (AMC) in Washington DC between March 2017 and March 2020.
Design: This prospective cohort study provided telemedicine consultation in endocrinology, nephrology and cardiology at a local FQHC. The FQHC served as the originating site and an AMC multispecialty group practice as the distant site. Clinical outcomes of study participants were compared with matched controls referred for in‐person specialty visits. No‐show rates and patient satisfaction were also examined.
Findings: Visit attendance data was analyzed for 834 visits. The no‐show rate was 15%. Adjusted OR for no‐show for TELE vs regular visits was 1.03 [0.66‐1.63], p = .87. There were no significant differences between intervention and control groups in clinical outcomes [p = .88 (A1c), p = 0.26 (MAP) and p = .90 (Scr) and p = 0.56 (eGFR) respectively]. Patients indicated high overall satisfaction with telemedicine.
Conclusions: This study, conducted pre‐pandemic, demonstrated equivalent outcomes in telemedicine management of diabetes, hypertension and kidney disease with high patient satisfaction in an urban underserved patient population. This hybrid model may help improve access to care.
Method: Observational
Classification of Research: Clinical Outcomes
Results: Visit attendance data was analyzed for 834 visits. The no‐show rate was 15%. Adjusted OR for no‐show for TELE vs regular visits was 1.03 [0.66‐1.63], p = .87. There were no significant differences between intervention and control groups in clinical outcomes [p = .88 (A1c), p = 0.26 (MAP) and p = .90 (Scr) and p = 0.56 (eGFR) respectively]. Patients indicated high overall satisfaction with telemedicine.
Conclusions: This study, conducted pre‐pandemic, demonstrated equivalent clinical outcomes and high patient satisfaction in the management of diabetes, hypertension and kidney disease via telemedicine in an urban underserved patient population. Care originated at a local FQHC, a critical and trusted source of primary care where access to specialty care is often limited. This hybrid care model provides another option to improve access to specialty care for underserved patients.
13. MEASURING TELEMEDICINE AND TELEHEALTH USAGE THROUGH NATIONAL HOUSEHOLD AND HEALTH CARE PROVIDER SURVEYS
Carol DeFrances, Kathleen O’Connor
Centers for Disease Control
Description: CDC’s National Center for Health Statistics (NCHS) conducts multiple household and health care provider surveys to monitor the health of the Nation. During the COVID‐19 pandemic, telemedicine questions were added to various NCHS household and health care provider surveys to gauge telemedicine usage.
Abstract: This presentation discusses NCHS’ efforts to fill an emergent and critical data need and provide timely information about telemedicine usage during the ongoing COVID‐19 pandemic. NCHS staff quickly developed and tested COVID‐related questions, including telemedicine questions and added them to ongoing national surveys as fast as practicable. Early in the pandemic, NCHS leveraged the Research and Development Survey (RANDS) to provide rapid interim experimental estimates of telemedicine usage. To keep information flowing, preliminary national estimates on telemedicine use were released from various health care and long‐term care provider surveys such as the National Post‐Acute and Long‐term Care Study (NPALS) and the National Ambulatory Medical Care Survey (NAMCS). Final national estimates are now available from the 2020 National Health Interview Survey, the principal source of information on the health of the civilian noninstitutionalized population of the United States. The most recent, selected, preliminary estimates of overall telemedicine and telehealth use will be presented across surveys to provide a snapshot across health care sectors, and by selected population subgroups to monitor disparities.
Method: Descriptive
Classification of Research: Clinician and Patient Experience
Results: Experimental estimates from RANDS showed in June‐July 2020, 36.6% of adult household respondents reportedly had a health care provider who offered telephone or video appointments; however, by May‐June 2021, this percentage decreased to 31.7%. On the provider side, preliminary data show prior to March 2020, 42.2% of office‐based physicians used telemedicine compared to 89.9% during and after March 2020. In the long‐term care sector, 39.6% of residential care communities reported using telemedicine from January 2020 – March 2021 to prevent or manage COVID‐19 infections. Among adult day services centers, 16.7% of facilities used telemedicine during the same time period.
Conclusions: As the COVID‐19 pandemic emerged, NCHS pivoted quickly to add COVID‐19 related questions to multiple national surveys and data systems. As the Nation’s principal health statistics agency, NCHS has produced timely and key COVID‐related estimates that demonstrate disparities in the availability and use of telemedicine and telehealth by health care providers and patients, and across selected population subgroups and health care sectors.
14. MODALITIES OF TELEMEDICINE DURING THE COVID‐19 ERA: DO PATIENT EXPECTATIONS VARY BETWEEN HOW THEY RECEIVE CARE?
Anders Carlson, Lis Ide
Zipnosis
Description: The telemedicine platform Zipnosis includes several options for asynchronous and synchronous hybrid care delivery, and routinely surveys patients after visits about their expectations. Response time, ease of use, and provider interaction exceed expectations however COVID‐19 concerns did not appear satisfactorily addressed. Hybrid virtual care generally exceeded expectations more than not.
Abstract: During the COVID‐19 pandemic, many health systems have relied on telemedicine to deliver quality, efficient care while respecting patient expectations and values. Hybrid care models, including options for asynchronous and synchronous virtual care seek to meet these needs and offer the best experience possible for individual patients. The white‐label telemedicine platform Zipnosis offers asynchronous and synchronous visits to over 50 partner health systems across the U.S., with synchronous visit options including chat, phone, or video. The platform also allows for hybrid telemedicine, where both the intelligent questionnaires and the providers completing visits having the ability to direct patients from one modality to another (e.g. from an asynchronous to a video visit or to step up virtual visits to in‐person care). To query patients regarding their virtual care experience, an online survey about patient satisfaction and expectations is emailed to patients 24 hours following any asynchronous or synchronous visit, and includes questions on “what was better than expected?” (12 options) and “what was worse than expected?” (16 options). In this retrospective, observational survey analysis, we present patient expectations by modality of care, depending on if they started their visit asynchronously, or synchronously with chat, phone, or video.
Method: Survey/Qualitative
Classification of Research: Patient Experience
Results: From March 1, 2020 to November 10, 2021, 78,684 surveys were returned (approximately 4% of all visits using Zipnosis during that period). When asked “what was better than expected?”, “quick response time” exceeded expectations most across all modalities (41%, 21%, 24%, 24% of visits by asynchronous, chat, phone, or video, respectively). “Interaction with provider” and “ease of use” were next most likely exceeding expectations. When asked “what was worse than expected?”, “COVID‐19 concerns” received most negative responses (21%, 14%, 17%, 21% of visits by asynchronous, chat, phone, or video, respectively); 94.5% of systems did not offer COVID‐19 testing via telemedicine.
Conclusions: Virtual care must adapt to patient expectations, especially during rapid changes precipitated by COVID‐19. In our hybrid virtual care platform, patients’ expectations were met or exceeded more often than not met, with greatest value seen in quick response times. Thus, virtual care may be more of a priority for patients prioritizing time. Notably, the interaction with a provider was also important to asynchronous visits, where such an interaction is expected to be least. Regarding COVID‐19 concerns, most healthcare systems did not offer testing via telemedicine, likely not meeting patient expectations. Overall expectations did not differ much between modalities of care.
15. PATIENT SATISFACTION WITH TELEMEDICINE DURING THE COVID‐19 PANDEMIC: AGE AND THE DIGITAL DIVIDE
Connie Shao
University of Alabama at Birmingham
Description: Telemedicine use has increased significantly during the COVID‐19 pandemic, increasing healthcare access, but exacerbating the digital divide. We found that failed video visits have the lowest satisfaction and are most common among older patients and those with public insurance, lower internet availability, and from lower median income ZIP codes.
Abstract: Rapid expansion of telemedicine during the COVID‐19 pandemic has exacerbated the digital divide. We studied demographic and socioecological determinants to predict when technical failure results in a planned video visit becoming a phone call (conversion).
Data for patients older than 18 years was abstracted from all ambulatory clinic surveys at a tertiary care center in the Deep South Mar‐Oct 2020. Patient satisfaction data was compared by patient demographics and visit type (phone, video, or conversion. Conversion was defined as a visit scheduled to be with video but reported by the patient to be via phone. Chi‐square analysis and ANOVA were used to compare groups. Logistic regression was used to predict patient satisfaction.
Increased conversion was correlated with increase in age (1.5% per year, p < 0.0001), public insurance (p < 0.0001), lower internet availability (0.7% per percent decrease in Internet availability, p < 0.0001), and lower median income of ZIP (7% per $10,000 decrease, p < 0.0001). On logistic regression, lower satisfaction was predicted by conversion (Conversion:Video OR:0.77, 95%CI:0.69‐0.86), male sex (OR:0.81, 95%CI 0.75‐0.89), and Department (Non‐Surgical:Surgical OR:0.79, 95%CI:0.69‐0.91).
Satisfaction is lowest among those experiencing conversion, which is most common among older patients and those with public insurance, lower internet availability, and from lower median income ZIP codes.
Method: Descriptive
Classification of Research: Patient Experience
Results: Satisfaction was lower for phone visits (59.8%) compared to video visits (63.8%), and lowest for converted visits (57.0%, p < 0.0001). Increased age and male sex decreased odds of satisfaction (3% per year p = 0.0009) (56.7% vs 61.7%, p < 0.0001). Surgical patients were more satisfied (64.1%) than non‐Surgical patients (60.5%, p = 0.002). Satisfaction was not correlated with median income of ZIP or Internet availability. On logistic regression, lower satisfaction was predicted by conversion (Conversion:Video OR:0.77, 95%CI:0.69‐0.86), male sex (OR:0.81, 95%CI 0.75‐0.89), and Department (Non‐Surgical:Surgical OR:0.79, 95%CI:0.69‐0.91).
Conclusions: Patient satisfaction with telemedicine is significantly lower among those who have phone compared to video visits, and even worse for those experiencing conversion. Older patients and those with public insurance, lower internet availability, and from lower median income ZIP codes are more likely to experience conversion, reflective of the digital divide. Satisfaction decreases with age, calling for increased accessibility of and assistance with video‐based telemedicine for older patients. Interventions to reduce conversion among these populations can improve satisfaction and quality as telemedicine becomes pervasive and permanent.
16. RAPID IMPLEMENTATION OF A DERMATOLOGY E‐CONSULT PROGRAM: A POTENTIAL MODEL FOR OTHER HEALTH SYSTEMS
Elizabeth V. Seiverling MD, Haya S. Raef MS, Jasmine A. Bishop MBA, Laura Houk MD, Rachel C. Alfiero BS, Madeline Prentiss BA, Hadjh T. Ahrns MD, Peggy R. Cyr MD
Maine Medical Center
Description: An Epic‐based store and forward electronic consultation (e‐Consult) platform was built allowing primary care providers to quickly connect with dermatologists and expedite care for patients with worrisome skin lesions. In the setting of COVID‐19, this rapidly implemented infrastructure expanded access to dermatologic care, streamlined triage, and led to cost savings.
Abstract: Demand for dermatology services in Maine was paramount even prior to the pandemic. At our institution, dermatology was the most common referral placed by primary care providers (PCPs). To improve access to care and triage for potentially worrisome skin lesions, we built an Epic‐based electronic consultation (e‐Consult) platform for our health system. The platform allows for high resolution clinical and dermoscopic image capture with pertinent clinical information to be transferred from PCPs to dermatologist for review through store and forward technology. A formal consultation report is generated by the dermatologist and sent to the PCP. We piloted the program with two primary care sites in early 2020 then rapidly expanded the platform due to COVID‐19 to 22 outpatient clinics within a 100‐mile catchment of Portland, ME. Here we present an analysis of 14 months of e‐Consults and highlight the impact of the program on access to dermatologic care for those in rural settings and cost of consultation.
Method: Implementation Science
Classification of Research: Access to Care
Results: A total of 488 e‐Consults were completed from April 2020 to April 2021. E‐Consults were utilized by the following specialties: family medicine (45%), pediatrics (29%), internal medicine (24%), and oncology (2%). Over 90% of the consults were completed within 72 hours. The majority (75%) of e‐Consults did not require a face‐to‐face (FTF) visit with a dermatologist. If a FTF visit was needed, the average wait time was less than 14 days, or less than one week for growths worrisome for melanoma. E‐consult led to an $185,562 reduction in cost of consultation over one year.
Conclusions: Dermatology e‐Consult expedites care for patients with skin disease, including melanoma. E‐Consult programs are particularly valuable in rural settings where patients have little to no access to dermatology services. The success of this program was in part due to partnerships with PCP site champions trained to use the e‐Consult platform. Close partnerships with PCPs allow for the transfer of knowledge, not patients, and result in high quality care, at lower cost, closer to home. By sharing this work, we hope to encourage other health systems to embrace e‐Consult as a means to improve access to care, especially in rural settings.
17. REMOTE PATIENT MONITORING (RPM) THROUGH THE NARRATIVES: LEVERAGING SPEECH AND FREE‐TEXT PATIENT GENERATED HEALTH DATA IN SHARED CLINICAL DECISION MAKING AND TELEHEALTH PRACTICE
Emre Sezgin, Garey Noritz, John Luna, Katelyn Krivchenia, Steve Rust, Syed‐Amad Hussain, Yungui Huang
NORC at University of Chicago/ Nationwide Children’s Hospital
Description: To facilitate remote patient monitoring (RPM), we developed a new natural language processing (NLP) pipeline of processing and synthesizing patient narrated or generated free‐text notes, then presenting relevant findings via a visual dashboard. We collected patient notes from 20 participants over a 2‐week period and tested feasibility of our model.
Abstract: Pandemic has accelerated the development and deployment of remote patient monitoring solutions, as in‐person patient visits have reduced, giving rise to the expanded needs of remote healthcare communications and health information sharing. Even though patient data generation is convenient, synthesis of notes requires intelligent mechanisms to facilitate its use in clinical decisions and patient communications. Today, several RPM systems are depending on quantifiable patient‐generated health data (PGHD) (e.g., vitals through sensors, self‐reported screening responses), opting out “narratives”, which is open‐ended responses or notes spoken or typed into medical diaries and applications. Medical diaries have been used to track health events in a number of medical domains, such as in behavioral health, neurology, or in other medical complexities, with rich information collected and to be communicated, yet fell short to be presented in a digestible format and adopted within the RPM technologies.
To use medical diaries for RPM and clinical decisions, we developed an NLP model to synthesize medical notes taken at home (free‐text, open‐ended notes, or transcriptions). The proposed model can extract a broad range of health information by combining rule‐based ontology‐linked approaches with pre‐trained deep‐learning‐based entity recognition and sentence parsing models.
Method: Model development and proof‐of‐concept
Classification of Research: Information Technology
Results: The model was tested with a combined dataset: (1) notes/transcriptions collected from caregivers of children with special healthcare needs (CSHCN) through a voice‐interactive app during the pandemic (n = 20, 75 notes taken in 2‐weeks period) and (2) simulated notes (30 notes). We extracted medication names, medications, dose, date medication taken, therapies, symptoms, bowel movements and nutrition from unstructured PGHD. To translate data into “digestible” formats, we prototyped a dashboard using Unity Software for data visualization on a timeline/calendar view. A multi‐stakeholder group (patient/caregivers, providers, researchers, designers, and developers) involved in the design and development of the visual dashboard.
Conclusions: We proposed a new technology and framework for augmenting remote care (and hybrid care) with the inclusion of patient/caregiver narratives in the equation. Implemented and deployed model can empower patients to improve self‐care and capture timely and accurate documentation, provide a holistic view to clinicians, enhance information sharing and shared decision making, and promote measurement‐based treatment using patient reported outcomes. The assessment showed that the proposed model and visual dashboard are feasible to implement and support remote care. The model could be integrated into mobile apps, web portals and electronic medical records to timely inform caregivers, patients, and providers.
18. TELEHEALTH EFFORTS AT THE CENTERS FOR DISEASE CONTROL AND PREVENTION
Antonio (Tony) Neri, Erin Abramsohn
Center for Disease Control
Description: A review of telehealth efforts at the Centers for Disease Control and Prevention (CDC), including partnerships with ATA and other public, private, and academic partners to identify and address facilitators and barriers to telehealth usage and continued efforts to synchronize telehealth‐focused efforts across CDC.
Abstract: The Centers for Disease Control and Prevention (CDC) rapidly scaled up efforts at the beginning of the COVID‐19 public health emergency to better understand telehealth usage, identify and address gaps in services, and coordinate CDC telehealth efforts being woven into routine activities. Efforts included a team dedicated to telehealth on the CDC COVID‐19 Response, a coordinated review of telehealth work across the agency, and development of a telehealth workgroup with research priorities. The COVID‐19 Response efforts included partnerships with ATA and other public, private, and academic partners to identify and address facilitators and barriers to telehealth usage using a health equity approach. These efforts included modifying national surveys, discussions with subject matter experts, information dissemination, and the development of automated and semi‐automated telehealth approaches to facilitate access to care and follow‐up on vaccine adverse events. The CDC‐wide telehealth workgroup continues to focus on synchronizing telehealth‐focused efforts across the agency. This presentation will provide updates on the impact of these efforts and next steps.
Method: Descriptive
Classification of Research: Access to Care
Results: Evaluation efforts still underway. Example: The Self‐Checker launched 3/23/2020 and was the first COVID‐19 symptom screener deployed by the US government. As of 10/2021 there have been more than 50 million visits worldwide. Preliminary evaluation efforts have indicated that approximately 50% of inquiries were for persons reporting no symptoms. CDCs V‐Safe post‐vaccination health checker is a semi‐automated approach that can result in the patient interacting with a caregiver if the reported symptoms appear to be more severe than expected. As of 10/2021 V‐Safe had 9.5 million users and collected 129 Million surveys. Evaluation efforts underway.
Conclusions: If the symptom checker diverted even a fraction of the 25 million people that used it and were reporting no symptoms from seeking care, tools like these have the ability to markedly reduced the number of unnecessary visits to an already overwhelmed healthcare system during the pandemic. CDC has the ability to combine this with surveillance and research capacity to better understand barriers and facilitating factors to using telehealth and telehealth‐adjacent technologies (automated and semi‐automated approaches) and work closely with public, private, and academic partners to increase use.
19. TOWARDS EQUITABLE TELEHEALTH EXPANSION: BARRIERS AND STRATEGIES ACROSS PATIENT AND CLINIC STAKEHOLDERS
Edmond Ramly, Jane Evered, Lelia Gessner, Reid Parks
University of Wisconsin‐Madison
Description: To support good care for all in the era of telehealth expansion, we engaged two 10‐person stakeholder advisory boards in participatory co‐design. We facilitated patient and clinic board 90‐minute sessions to identify barriers and strategies to good care. We present an integrated and thematically mapped inventory of barriers and strategies.
Abstract: Telehealth use increased rapidly during the COVID‐19 pandemic. Previous studies of barriers and strategies to support telehealth access, uptake, and sustainment often focused on either the patient or provider perspective. Additionally, the rapid telehealth expansion warrants updated research through an equity lens. We aim to bridge patient and provider perspectives during this dynamic time by integrating multiple‐stakeholders’ perspectives on telehealth expansion.
To support good care for all in the era of telehealth expansion, we engaged two 10‐person stakeholder advisory boards in participatory co‐design. We leveraged an existing patient advisory board and convened a new clinic board of heterogeneous staff and clinicians from a local federally qualified health center. Between May and November of 2021, we facilitated alternating patient and clinic board 90‐minute sessions to identify barriers and strategies that support good care for all in the context of telehealth expansion. In between sessions, our multidisciplinary research team compiled barriers and strategies from transcripts and collaborative session materials. In content analyses, we inductively grouped barriers and strategies across patient and clinic session data and refined groupings based on feedback from each board and clinical collaborators with health equity and stakeholder engagement expertise.
Method: Survey/Qualitative
Classification of Research: Access to Care
Results: Telehealth barrier and strategy themes spanned patient and clinic perspectives on telehealth implementation, experience, and access. Implementation themes included scheduling, workflow, and clinic‐side technology. Experience themes covered appointment environment, communication, expectations for telehealth visit, and provider‐patient relationship. Access themes spanned health literacy, missing health information, money, concerns about telehealth, patient‐side technology, and person characteristics. Some themes covered multiple; concerns with telehealth can also affect one’s experience and reflect its local implementation. In a secondary finding about virtual co‐design sessions, screen‐sharing real‐time notes on slides generated more discussion and topics than navigating to an online whiteboard for brainstorming with sticky notes.
Conclusions: This study provides an inventory of barriers and matching strategies to good care with telehealth from the perspectives of both patients and clinic stakeholders as an updated and equity‐minded resource for clinics optimizing or newly implementing telehealth, to promote equitable telehealth expansion. Future directions include incorporating more clinic and patient perspectives across disadvantaged and advantage urban and rural areas and refining and organizing the inventory into an interactive online tool to help clinics with telehealth implementation and optimization by systematically tracking local barriers from a menu of known options linked to a menu of known strategies.
20. TREATMENT OUTCOMES FROM A RANDOMIZED CONTROL TRIAL OF A NUDGE‐STYLE INTERVENTION ON A TELEHEALTH PLATFORM
Megan Zhou, Tanya Jain
Ro
Description: Nudge‐style interventions, small behavior triggers that encourage positive choices rather than restricting unwanted ones, are becoming increasingly common in clinical practice. There has been recent interest in investigating the ability of digital health technology, including telehealth platforms, to support health promotion through nudges.
Abstract: The objective of this randomized control trial was to evaluate whether receiving a nudge‐style intervention two weeks after treatment initiation on a direct‐to‐consumer telehealth platform would result in greater treatment adherence. In the trial, patients receiving PDE‐5 inhibitor treatment for erectile dysfunction on the telehealth platform were randomised to receive the nudge intervention or not. The study population consisted of 2,000 randomly sampled patients. The nudge intervention consisted of a short online questionnaire prompting patients to report treatment satisfaction and medication side effects to their providers. The main outcome assessed was whether patients completed a prescription refill within 91 or 123 days (depending on whether they had an initial 1‐month or 3‐month supply, respectively) of initiating treatment. The secondary outcome assessed was medication adjustment, which was defined as a change in medication type, quantity, and/or dosage.
Method: Randomized Controlled Trial
Classification of Research: Clinical Outcomes
Results: Compared to patients in the control group, the treatment group were more likely to refill their prescription, both over the duration of the study period (p = 0.04) and by the end of the study period, controlling for age and medication adjustment (OR 1.21, 95% CI: 1.03, 1.44). More treatment group patients adjusted their medication (5.4%) than those in control (3.3%) (p = 0.028). The adjusted odds of prescription refill was 3.18 times higher (95% CI: 1.84, 5.99) for those who adjusted their medication, compared to those who did not adjust medication.
Conclusions: Nudge‐style interventions have the potential to improve the quality of care for patients receiving virtual treatment for erectile dysfunction. Our RxCI intervention helped patients communicate with providers and adjust their medication, which ultimately improved treatment adherence.
21. USING QUALITATIVE DATA TO GUIDE QUALITY IMPROVEMENT AND VIRTUAL HEALTH INNOVATIONS IN BRITISH COLUMBIA’S POST‐COVID RECOVERY CLINICS
Adeera Levin, Amir Rasheed, Jaclyn Robinson, Joyce Chan, Julie Wei, Marlee McGuire, Michelle Malbeuf
Providence Health
Description: British Columbia’s post‐COVID Recovery Clinics deliver a mix of in person and virtual care to increase equity, capacity, and geographic reach. A patient experience evaluation comprised of fourteen interviews and a survey illuminated virtual health improvement and innovation opportunities tailored to the experience of this emerging chronic disease.
Abstract: Approximately 10% of people who have had COVID‐19 will experience what are called ‘long hauler’ symptoms, including brain fog, shortness of breath, pain, chronic fatigue, and anxiety. British Columbia’s four post‐COVID Recovery Clinics (PCRCs) situated within regional health authorities provide care to long hauler patients, and the provincially led post‐COVID Interdisciplinary Care Network coordinates best practices, education, and research for the PCRCs. Virtual visits are employed within this model of care to increase equity, capacity, and geographic reach.
A patient experience evaluation of the PCRCs was conducted by the Office of Virtual Health at the Provincial Health Services Authority. The evaluation sought to hear from patients experiencing both in person and virtual visits.
The provincial virtual health evaluation framework guided the design of the evaluation areas of inquiry, and the evaluation methods were developed using Sangaramoorthy and Kroeger’s rapid ethnographic assessment approach. Three patient partners were engaged in the development of the areas of focus for the evaluation and in the writing and editing of the survey questions and interview guides. The survey was developed in English and professionally translated into Tagalog, Punjabi, and Simplified and Traditional Chinese. 219 patients completed the survey, and fourteen patients participated in semi‐structured interviews.
Method: Survey/Qualitative
Classification of Research: Patient Experience
Results: In the survey, 36% of virtual visit PCRC patients said a virtual visit was their preference, 34% would have preferred an in‐person visit, and 30% were not sure. In comparison with in‐person visits, 87% of patients said an in‐person visit was their preference, 3% would have preferred a virtual visit, and 10% were not sure. Putting this in context, interviewees described that they found providers were much more business‐like and brief during virtual visits than during previous in‐person visits. Several virtual health improvement and innovation opportunities were identified by patients as they shared their healing and recovery journeys.
Conclusions: Incorporating qualitative inquiry into virtual health patient experience evaluations adds necessary context to survey data. Qualitative data shows that virtual visit experience cannot be separated from general expectations around the patient/provider relationship. Additionally, developing virtual health solutions around the experience of disease as a starting point will facilitate quality and experience improvement. PCRC patients shared how the brain fog associated with their condition permeates their experience as a clinic patient, and identified virtual and digital solutions that could help mediate and make it easier to partner with the PCRCs in their recovery. This interweaves virtual health innovation with accessibility imperatives.
Poster Presentations
1. 24‐HOUR AMBULATORY BLOOD PRESSURE MEASUREMENT USING A NOVEL NON‐INVASIVE, CUFF‐LESS, PPG‐BASED WIRELESS DEVICE: ACCURACY, FEASIBILITY, AND PATIENT AND MEDICAL STAFF SATISFACTION
Arik Eisenkraft, Dean Nachman
The Hebrew University Faculty of Medicine
Description: We describe a comparison of 24‐hour ABPM between a cuff‐based device and a novel PPG‐based cuffless device, showing high accordance. The novel device was simple and user friendly, easy to train and operate, the rate of malfunctions was low, and the satisfaction rate of patients, technicians, and physicians was high.
Abstract: Cuff‐based ambulatory blood pressure monitoring (ABPM) devices are used for the diagnosis and treatment of hypertension. Technical limitations and low compliance limit their use. In this study, we tested the accuracy of a new photoplethysmography‐based, wearable device as compared to a cuff‐based ABPM device. 24H ABPM was performed in parallel on volunteers aged 18‐65 years while documenting their daily activities. Using linear regression, Bland‐Altman, and Receiver Operating Characteristic (ROC) curve analysis we evaluated the agreement between devices and classified hypertension. The study included 54 subjects. Bland‐Altman analysis resulted in a 24H bias of ‐1.1 mmHg for diastolic and systolic blood pressure (DBP & SBP). Mean daytime bias was ‐1.9 mmHg for both, while nighttime bias was smaller. ROC curve analysis yielded a mean area under the curve of 1 for SBP and 24H BP measurements, and 0.994 and 0.955 for daytime and night DBP, respectively. 24H ABPM caused significantly less inconvenience than the cuff‐based device (p < 0.001). The novel device was simple and user‐friendly, easy to train and operate, and the satisfaction rate of patients and physicians was high. The cuffless device provides comparable measurements to the currently used cuff‐based devices, with significantly less inconvenience to the subject.
Method: Observational
Classification of Research: Survey/Qualitative, Descriptive, Implementation Science, Access to Care
Patient Experience, Clinician Experience, Clinical Outcomes, Quality Improvement, Regulatory & Policy Research, Information Technology, Measurement Frameworks & Tools
Results: The comparison study included 28 subjects. Bland‐Altman analysis resulted in a 24H bias of ‐1.1 mmHg for both diastolic and systolic blood pressure (DBP & SBP). Mean daytime bias was ‐1.9 mmHg for both, while nighttime bias was smaller. The novel device caused significantly less inconvenience (p < 0.001). 26 participants, 10 physicians, and 3 nurses were included in the workflow analysis. The novel device received a high score ranging from 9.3‐10 in all aspects (attachment, esthetics, time‐to‐complete admission, technical handling, and comfort). A high satisfaction rate was found by patients, and by physicians for data presentation and the final report.
Conclusions: The cuff‐less device provides comparable measurements to those obtained with the currently used cuff‐based ABPM device, with significantly less inconvenience to the subject. The novel device is simple and user‐friendly, easy to train and operate, and the rate of malfunctions was found to be low. Moreover, the satisfaction rate of patients, technicians, and physicians was high. The automatically‐generated report allows increased efficiency in terms of labor and analysis costs, and the patients do not need to return to the clinics as the sensor is disposable.
2. A RETROSPECTIVE STUDY ON VULVOVAGINITIS TREATMENT OUTCOMES VIA AN ASYNCHRONOUS TELEHEALTH PLATFORM
Jiaxin Dai, Melina Martinez, Mary Jacobson
Hello Alpha
Description: A majority of women have had vulvovaginitis in their lifetimes. Telemedicine provides timely and accessible care for patients. However, data on patient outcomes via telemedicine is lacking. To our knowledge, this is the first paper to examine treatment outcomes of vulvovaginitis in women via an asynchronous telemedicine platform.
Abstract: Data on patient outcomes for vulvovaginitis via telemedicine is lacking. To our knowledge, this is the first paper to examine treatment outcomes of vulvovaginitis in women via an asynchronous telemedicine platform. We conducted a retrospective chart review to assess the treatment outcomes of patients seeking care for vulvovaginitis via an asynchronous telemedicine platform between June 2020 and August 2021. We evaluated patient demographics, symptoms, empiric diagnosis of type of vulvovaginitis, prescribed medication(s), adverse events, and treatment effectiveness in 4233 eligible patients. Patient visits originated from 45 U.S. states; the largest percentage were from the South (47.9%). Empiric diagnoses in patients were: bacterial vaginosis (BV) in 1966 (46%), vulvovaginal candidiasis (VVC) in 1978 (47%), and both BV and VVC in 268 (6.3%). Twenty‐one (0.5%) patients were referred for further testing or in‐person care. Prescribed medications were concordant with guidelines from the IDSA (VVC) and CDC (BV) in 90.7% of cases. The treatment success rate was 97.7% (4133/4233). Thirty‐seven patients reported mild adverse events. Overall, patients treated for vulvovaginitis symptoms via an asynchronous telemedicine platform received guideline‐concordant medical care which was safe and highly effective. Referral for in‐person management was rare.
Method: Retrospective chart review
Classification of Research: Clinical Outcomes
Results: A total of 4469 patients sought care via telemedicine in the United States for vulvovaginitis; 4233 patients were eligible for study inclusion. Empiric diagnoses in patients were: bacterial vaginosis (BV) in 1966 (46%), vulvovaginal candidiasis (VVC) in 1978 (47%), and both BV and VVC in 268 (6.3%). The remaining 21 (0.5%) patients were referred for further testing or in‐person care. Prescribed medications were concordant with guidelines from the IDSA (VVC) and CDC (BV) in 90.7% of cases. The treatment success rate was 97.7% (4133/4233). Thirty‐seven patients reported mild adverse events.
Conclusions: Patients treated for vulvovaginitis symptoms via an asynchronous telemedicine platform received guideline‐concordant medical care which was safe and highly effective. Referral for in‐person management was rare. Our findings indicate that telemedicine is a convenient and effective care option.
3. ACCEPTABILITY AND IMPLEMENTATION OF AN ONLINE COGNITIVE BEHAVIORAL THERAPY PLATFORM
Sara Chokshi
HITLAB
Description: This is a study of the useability, acceptability and implementation of an online CBT platform in a large, urban behavioral health clinic.
Abstract: Cases of major depressive disorder and anxiety are estimated to have increased by more than a quarter worldwide in 2020, largely attributed to the Covid‐19 pandemic. Digital tools have the potential to expand mental health service providers’ capacity to meet this growing demand, particularly Covid‐related depression and anxiety. We studied a novel platform designed to deliver asynchronous, module‐based cognitive behavioral therapy (CBT) to patients for common mental health conditions such as depression, anxiety and post‐traumatic stress disorder, to evaluate the usability and acceptability of the platform and assess the implementation of the platform into clinical and administrative workflows. Working with a large, urban behavioral health clinic we recruited 5 clinical psychology trainees to use the platform with their patients (n = 20) to complete 4 modules of a Covid‐focused CBT content. After a brief training on delivery of online CBT and features of the platform, clinicians and their patients used the platform for 4 weeks.
Method: Survey/Qualitative
Classification of Research: Clinician Experience, access to care
Results: At endline, clinicians as well as the clinic administrator completed a semi‐structured interview designed to elicit useability and acceptability insights as well as implementation facilitators and barriers related to integrating online CBT into their practice. Patient mental health outcomes (depression and anxiety symptoms) were gathered at the beginning and end of the study period as part of routine use of the platform and included in this analysis.
Conclusions: Online CBT has the capacity to expand clinicians’ ability to address the growing need for mental health services in the U.S. and globally. Studying and addressing the acceptability and implementation barriers to integrating online platforms is key to realizing the potential of these platforms.
4. APPROPRIATE CARE DELIVERED VIRTUALLY FOR ACUTE UPPER RESPIRATORY INFECTION ‐ RESULTS FROM A NATIONAL ADVANCED PRIMARY CARE ORGANIZATION
Nathaniel Madsen, Tessa Lannoy
One Medical
Description: Telemedicine has been associated with higher antibiotic prescribing rates for URIs. As a nationwide practice, we investigated the quality of care delivered to our patients. Our focus was antibiotic prescribing rate, as a measure of appropriateness of care, by an APP‐lead virtually only team to compare to the national average.
Abstract: Acute upper respiratory tract infections (URIs) are among the most common reasons for a healthcare encounter in the United States. Prior to COVID several articles came out associating telemedicine with higher antibiotic prescribing rates for URIs (upper respiratory tract infections), especially in pediatric patients. As most clinicians are aware, since 2015 The Choosing Wisely Campaign and ISDA have strongly recommended avoiding antibiotics for URIs and the national prescribing rate has trended downwards in most areas except for telemedicine. These higher prescribing rates in telemedicine suggest the quality of care in telemedicine may be lower than in‐person visits.
One Medical is a national primary care team‐based organization with both in‐office and virtual‐only care options. As a practice group we wanted to look at the quality of care we deliver to our patients. We chose to use the antibiotic prescribing rate by our virtual medicine team to compare our clinical effectiveness to the national average of office based providers.
Method: Survey/Qualitative, Qualitative/observational
Classification of Research: Clinical Outcomes, Clinical outcomes and patient experience
Results: There have been few formal studies evaluating telemedicine quality. Those that have been done show 58‐66% of patients receive an antibiotic prescription for an URI from a telemedicine encounter. Since there is little data related to telemedicine prescribing rates we also looked at office providers where 49% of patients received an antibiotic prescription for an URI from an office‐based encounter from 2000‐2012.
Analysis of our data showed that we prescribe antibiotics 10.5% of the time for telemedicine encounters related to URIs.
Conclusions: A team‐based model shows antibiotic prescribing rate for URIs is significantly lower than even our office colleagues and we can conclude that we are providing quality care despite our care being delivered via telemedicine.
5. CASE MANAGERS’ PERCEPTIONS ABOUT SYNCHRONOUS TELEREHABILITATION VERSUS CLINIC‐BASED PHYSICAL THERAPY SERVICES FOR PEOPLE WITH SPINAL CORD INJURY
Steve Kerschke
Quality Living, Inc.
Description: Many professionals remain reluctant to suggest delivery of physical rehabilitation for people with spinal cord injury (SCI) via telerehabilitation, especially when clinic‐based services are available. This survey study explored case managers’ perceptions regarding advantages and disadvantages of synchronous telerehabilitation versus clinic‐based physical therapy services for people with SCI.
Abstract: People with spinal cord injury (SCI) require extensive rehabilitation to maximize independence and quality of life. Much of this treatment occurs on an outpatient basis through telerehabilitation or clinic‐based services. Synchronous telerehabilitation has become increasingly common in recent years, but many professionals remain reluctant to suggest it, especially when clinic‐based services are available. This survey study explored case managers’ perceptions regarding advantages and disadvantages of providing physical therapy for people with SCI via synchronous telerehabilitation versus clinic‐based services. Respondents were 89 case managers responsible for service provision coordination. Results showed a significant preference for clinic‐based rather than telerehabilitation as a service delivery model for providing physical therapy. Relative experience with the two service delivery models significantly affected perceptions. Only facilitating travel convenience differed significantly as a reason for recommending one service delivery method over the other. The incongruity between perceptions about synchronous telerehabilitation and existing literature about its cost, convenience, and efficacy suggests a need for additional education.
Method: Survey/Qualitative
Classification of Research: Access to Care
Results: Respondents comprised 3 groups based on telerehabilitation experience; 75% of case managers are unfamiliar with synchronous telerehabilitation. A significant positive correlation and large effect size emerged between telerehabilitation familiarity and recommendation likelihood. Kruskal‐Wallis and post‐hoc testing confirmed that greater familiarity yielded significantly less difference in the likelihood of recommending telerehabilitation versus clinic‐based services.
Case managers significantly favored clinic‐based over telerehabilitation services for 11/13 quality/effectiveness and 2/4 therapist‐client interaction items. Telerehabilitation was judged significantly superior for 3/4 convenience/access items.
Disability severity and clinician expertise were the most frequent reasons for recommending clinic‐based services; travel convenience was the only significantly different factor favoring telerehabilitation.
Conclusions: Synchronous telerehabilitation remains an unfamiliar service delivery model to most case managers despite its increased use secondary to COVID‐19 restrictions. Lack of familiarity equates with infrequent recommendation of the service delivery option; additional research and education to inform professionals about benefits and detriments are warranted. Not only is using technology to access services remotely essential in some circumstances, existing research suggests it is a viable and equal alternative to clinic‐based service delivery in many respects. Limited knowledge results in persistence of the belief that clinic‐based service delivery is a superior option for most people in need of physical therapy interventions.
6. EFFECTS OF A DIGITAL MENTAL HEALTH PROGRAM DESIGNED FOR ADOLESCENTS: PRELIMINARY RESULTS ON PERCEIVED STRESS AND BROODING
Acacia Parks, Cynthia J. Miles, Eliane Boucher, Haley Ward, Ryan Honomichl
Happify Health
Description: This study examined differences in perceived stress and brooding among adolescents aged 13 to 17 who were randomly assigned to a digital mental health intervention designed for adolescents or to a waitlist control. The current data represent preliminary findings from this ongoing study, focusing on changes at 4 weeks.
Abstract: Stress is an important transdiagnostic risk factor in adolescence, predicting a variety of physical and psychological problems that begin in adolescence and continue in adulthood. Although adolescents report high levels of stress, even higher than among adults during periods of time they are enrolled in school, adolescents report engaging in few, if any, stress management techniques. Developing effective programs that help address adolescent stress is therefore critically important; however, most current stress management programs are deployed within school and rely on traditional stress management techniques rather than incorporating methods to address the underlying negative cognitive processes, such as rumination, that may contribute to, or exacerbate, the effects of perceived stress. In this study, we tested the short‐term effects of a new digital mental health intervention (DMHI) designed for adolescents aged 13 to 17. Adolescents (N = 161) with elevated levels of perceived stress and brooding were randomly assigned to engage with the DMHI or to a waitlist control, and we examined changes in perceived stress and brooding after 4, 8, and 12 weeks. The preliminary data discussed here show that adolescents assigned to the DMHI condition showed significantly greater improvements after 4 weeks relative to the waitlist control group.
Method: Randomized Controlled Trial
Classification of Research: Clinical Outcomes
Results: Using linear mixed effect models with random intercept, we examined main effects for condition (intervention vs. waitlist) and time (baseline vs. 4 weeks), and the corresponding interaction. We found significant interactions for both perceived stress and brooding (ps < .001). There was significantly more improvement in perceived stress among participants in the intervention condition (baseline: 26.05, 4‐week: 22.32) relative to those in the control condition (baseline: 24.86, 4‐week: 24.46). Similarly, improvements in brooding were significantly greater in the intervention condition (baseline: 13.98, 4‐week: 12.58) compared to the waitlist control (baseline: 14.07, 4‐week: 14.22).
Conclusions: These preliminary results demonstrate that adolescents who engaged with the DMHI experienced significant reductions in perceived stress and brooding after four weeks, above and beyond what was observed in the waitlist control group. Although additional research is needed to understand whether these effects are sustained, this suggests that increasing the availability of DMHI designed for adolescents may be a scalable and effective approach to addressing growing concerns with adolescent mental health.
7. ENVIRONMENTAL IMPACT OF TELEMEDICINE IN AN NCI DESIGNATED ONCOLOGY CANCER CENTER
Krupal Patel
Moffitt Cancer Center
Description: This study assesses the environmental impact of telemedicine, by measuring reducting in carbon emissions, in an oncology practice.
Abstract: Recent report from World Health Organization has reported dire consequences of global warming. Global carbon dioxide (CO2) emissions fell by 6.4% or 2.3 billion tonnes in 2020 during COVID‐19 pandemic’s restrictions in travel and reduction in various other economic activities. U.S. led the reduction in emissions with nearly 13% decrease mostly due to decrease in transportation. Transportation is currently the largest source of greenhouse gas emissions in the U.S., having surpassed electricity generation in 2016. While the lockdowns and restrictions were being put in place, rapid adoption of telemedicine was underway to provide access to care. Aim of this study was to report analysis of CO2 savings from implementation of telemedicine at a National Cancer Institute (NCI)‐designated cancer treatment center.
We analyzed telemedicine visits from April 1, 2020 to Jun 30, 2021. Round trip carbon emissions were calculated using patient’s addresses. In order to determine the CO2 amounts saved for vehicle travel we used EPA emissions calculator (411 grams of CO2 per vehicle per mile multipled by miles travelled).
Significant reduction in carbon emissions was noted.
This study demonstrates the added benefit of telemedicine in reducing carbon emissions.
Other (see below to indicate other method)
Method: Retrospective
Classification of Research: Regulatory & Policy Research
Results: From April 1, 2020 to Jun 30, 2021, a total of 49,448 virtual visits were conducted at an NCI designated cancer center, with a total of 7,724,981 round trips miles being saved in travel. The carbon emission analysis is being compeleted.
Conclusions: Telemedicine has a significantly positive impact in reducing carbon emission.
8. HOW EVIDENCE‐BASED TELEMEDICINE DRIVES INITIATION AND ENGAGEMENT IN TREATMENT FOR AUD
Andrey Ostrovsky, James Besante
Monument
Description: In a June 2021 study, evidence‐based telemedicine treatment for alcohol use disorder had far greater levels of initiation and engagement in treatment than relative HEDIS measures. Given the growing alcohol epidemic, expanding access to quality, AUD treatment can improve outcomes, reduce inequity, and lower the total cost of care.
Abstract: Background and Objective: Pharmacologic and nonpharmacologic interventions reduce excessive alcohol use, and this treatment approach can be applied in a virtual care setting.
Telemedicine can offer high value care, combining community based peer support, psychotherapy and physician care. By providing affordable and accessible treatment options to patients with alcohol use disorder, we can improve the quality of care and lowers barriers to treatment.
Our objective: evaluate the initiation and engagement of patients on the Monument telemedicine platform relative to HEDIS measures.
Initiation in Treatment: the percentage of applicable plan members who “initiate treatment” within 14 days of enrolling in a treatment plan.
Engagement in Treatment: the percentage of applicable plan members who engage 2 or more times within 34 days of their first successful appointment.
Note: Qualifying engagements include booking or attending a second appointment, RSVPing to or attending a therapist‐moderated group session, or receiving a prescription for medication.
The sample of members who signed up on the platform was N:158, and it was made up of 35.4% male and 64.6% female members, average age 44.3.
Method: Observational
Classification of Research: Access to Care
Results: The study found that 97.5 percent of patients who signed up initiated treatment on the platform within 14 days, exceeding 2018 HEDIS measures ranging from 36.6% to 41.6%.
It also found that 80.3 percent of patients engaged 2 or more times within 34 days of initiation in treatment, exceeding 2018 HEDIS Measures ranging from 4.6% to 13.6%.
An important limitation in the study is that there may be confounding variables between historical interventions and current controls. However, the magnitude of the change indicates there is a statistically significant difference.
Conclusions: We suspect the large improvement in initiation and engagement in treatment to be attributable to improved convenience and access to treatment. Some potential reasons for this include reduced stigma, no wait time for certain levels of care, and no constraints due to transportation.
There is opportunity to integrate better screening and care coordination for AUD throughout the health system, making patients aware of telemedicine‐based options available to support their unhealthy alcohol use.
9. IMPLEMENTATION AND POPULATION CHARACTERIZATION OF THE CHILD AND ADOLESCENT TELEPSYCHIATRY OUTPATIENT UNIT IN THE CLINICA LA INMACULADA (BOGOTA DC, COLOMBIA)
John Douglas, Jose Francisco, Cepeda‐Torres, Oscar Ribero
Contreras Hermanas Hospitalarias del Sagrado Corazon de Jesus
Description: The following work aims to describe the implementation process and characterization of the population of the Child and Adolescent Telepsychiatry Outpatient Unit in the Clinica La Inmaculada, in Bogota DC, Colombia.
Abstract: In June of 2021, the Clinica La Inmculada in Bogota DC (Colombia) created and implemented an Outpatient Child and Adolescent Telepsychiatry service in order to guarantee access to specialized care to the local population. While its implementation took place during a state of health emergency, the clinic’s scope goes beyond the circumstances generated by the COVID‐19 pandemic, and aims to keep providing this services in order to maintain access and continuity of the therapeutic processes in spite of geographical barriers, transportation problems, and public order situations, while also expanding its reach. The following study describes the implementation process and provides a characterization of the population cared for by the Child and Adolescent Telepsychiatry Outpatient Unit, as a means to show that telemedicine is a viable and effective strategy to provide specialized mental health care to children, teens and their families.
Method: Descriptive
Classification of Research: Access to Care
Results: Since its creation, the Outpatient Child and Adolescent Telepsychiatry Unit has managed to provide specialized mental health care services to a growing number of patients, guaranteeing access and continuity in their therapeutic processes. As this is clinic’s first step of a larger project aimed to provide other techonology based mental health services, a population characterization and analysis was performed to direct the creation of new services or extend the reach of those that already exist.
Conclusions: The Outpatient Child and Adolescent Telepsychiatry Unit at Clinica La Inmaculada is the result of careful preparation, learning, and a coordinated effort to make use of technology as an essential tool for the provision of a specialized, high quality, powerful, efficient and accessible service. It is also the first step in a larger‐scale project that seeks to offer mental telehealth services to the child and adolescent population locally and in other national territories.
10. INFLUENCE OF VIDEOCONFERENCING ON BREASTFEEDING SELF‐EFFICACY, RATES, AND DURATION
Grant Nordby, Lynne Heithoff
Faith Regional Health Services
Description: Research questions: What influence does scheduled lactation Video‐conferencing (VC) sessions (independent variable) have on a mother’s self‐efficacy, rates, and duration of breastfeeding (dependent variable); How is a mother’s self‐efficacy (dependent variable) influenced by providing scheduled VC (independent variable) for lactation consultations.
Abstract: The rate of mothers exclusively feeding breastmilk to their infants (no artificial milk or water) is below target levels established by the Centers for Disease Control and Prevention (2018). Many studies investigated improving breastfeeding rates through various interventions, but very few utilized telehealth videoconferencing (VC). This was surprising considering the widespread use of smartphones and other personal communication. The purpose of this quality improvement study was to evaluate the relationship of adding an intervention of lactation consultations via telehealth VC on self‐efficacy, rates, and duration of breastfeeding. This study sought to provide insight on utilizing lactation telehealth VC to increase availability of support and education, while also seeking how this relates to a mother’s self‐efficacy, rates, and duration of breastfeeding in a Midwest 128‐bed regional hospital. The results indicated significantly increased self‐efficacy in mothers who exclusively breastfed for 12 weeks postdelivery. The rate and duration of exclusive breastfeeding was not statistically significant. However, there was an increase in 12‐week exclusive breastfeeding from 46% in the pre‐intervention group to 67% in the intervention group.
Keywords: breastfeeding, telehealth, videoconferencing, tele‐lactation, lactation support
Method: Survey/Qualitative
Classification of Research: Clinical Outcomes, Patient Experience
Results: 17 out of 37 (46%) of the pre‐intervention cohort exclusively breastfed at least 12 weeks compared to 12 out of 18 (67%) of the intervention cohort. There was a significant increase in self‐efficacy scores in the group who continued to exclusively breastfeed at 12 weeks postdelivery. The mean self‐efficacy score of this group was 43.92 upon discharge from the hospital and 64.25 at 12 weeks postdelivery. This was an increase of 20.33. The highest possible score was 70.
Conclusions: Lactation services are often sought by mothers who feel they are having difficulty with breastfeeding. This study indicated continuing education through scheduled follow‐up VC sessions benefitted all breastfeeding mothers, not just those with perceived breastfeeding issues. Mothers are not always familiar with future breastfeeding roadblocks and how to navigate those issues. During lactation VC sessions, education about possible future roadblocks such as returning to work, baby’s growth spurts, milk supply etc. can be addressed. This VC service provided a give‐and‐take opportunity for mothers to ask questions and get information in a more personalized, real‐time format.
11. MDTOK ‐ BRINGING GLOBAL RESOURCES TO SUPPORT LOCAL COVID‐19 HIT POPULATION!
Abhijeet Nakave, Hemraj Gaidhani, John Pletka
Mdtok Corporation
Description: During COVID‐19 pandemic, telemedicine was one of the effective combat tool used in many countries. MDtok telemedicine platform was able to engage 300+ doctors from across the world to see more than 3,500 patient encounters in few weeks during the second Covid‐19 wave in India in May 2021.
Abstract: COVID‐19 pandemic effects are seen globally where many economies and healthcare systems came to their knees due to the massive and rapid spread. MDtok telemedicine platform was designed and developed by doctors and engineers together to effectively deliver the healthcare expertise intercontient and beyong the state borders.
With COVID‐19 travel restrictions in India, lack of access to tertiary healthcare facilities, shortage of healthcare providers, shortage of medications and oxygen, the Indian healthcare system was overburdened during the month of April and May, 2021. After recording more than 300,000 new infections in April, India reported over 400,000 new cases on May 1 alone in a single day.
MDtok platform was launched on world wide web in late April and more than 300 doctors from USA, Canada, United Kingdom, Singapore, UAE joined to deliver telemedicine services to Indian patients. There were more than 150,000 visits to the webpage and 3500+ video consultations were completed by doctors with more than 20,000 audio consultations connective global doctors to pandemic hit population.
The utilization of global healthcare providers via MDtok in COVID‐19 hit population was immensely helpful to support local health system and many patients received second opinion, primary prevention advice and medical treatment via telemedicine.
Method: Observational
Classification of Research: Information Technology
Results: The utilization of global healthcare providers via MDtok in COVID‐19 hit population was immensely helpful to support local health system and many patients received second opinion, primary prevention advice and medical treatment via telemedicine.
Results: Use of telemedicine technology should not be limited to one specific institution, practice, city, state or country. Healthcare experts are spread across the globe and telemedicine is an effective tool to bring their expertise under one umbrella to deliver the effective patient care in most cost‐effective way.
12. PATIENT SATISFACTION OF TELEMEDICINE ADOPTION IN A NCI DESIGNATED CANCER CENTER DURING COVID‐19 PANDEMIC USING PRESS GANEY SURVEY
Krupal Patel
Moffitt Cancer Center
Description: The objective of this study was to assess patient experience using Press Ganey outpatient and telemedicine surveys in a NCI‐designated cancer center overtime from January 2020 through June 2021.
Abstract: Cancer patients require timely consultations in a multidisciplinary care setting to prepare an optimized treatment plan with significant implications towards quality of life and mortality. Traditional visits allowed for clinician‐patient engagement where these complex decisions could be made in‐person. Telemedicine is here to stay and thus it is important to assess patient experience of the care they receive through this platform in an oncologic setting to ensure value‐based care is delivered.
The objective of this study was to assess patient experience using Press Ganey outpatient and telemedicine surveys in a NCI‐designated cancer center overtime from January 2020 through June 2021.
Method: Retrospective
Classification of Research: Patient Experience
Results: A total of 653,039 patients were seen as in‐person visit and 85,645patients as telemedicine visits from April 1, 2020 – Jun 2021. A total of 74,072 patients had Press Ganey data for in person visits. A total of 6,888 patients had Press Ganey data for telemedicine visits.
Preliminary results suggest significant improvement in scores in access to care domain while maintaining high scores in satisfaction in quality of care received domain.
Conclusions: Telemedicine improves access to care while maintaining high scores in satisfaction in quality of care received domain.
13. PERINATAL TELEMEDICINE IN MARYLAND – A LANDSCAPE ANALYSIS
Andreea A. Creanga, Meighan Mary, Priyanka Das, Johns Hopkins
Description: A landscape analysis was conducted on the availability of perinatal telemedicine services at lower‐level birthing hospitals in Maryland to inform the design and implementation of a statewide perinatal telemedicine and telementoring network.
Abstract: OBJECTIVE: To assess the perinatal telemedicine (PTM) landscape in Maryland and inform the design and implementation of a PTM network linking the two Level IV hospitals Level I/II birthing hospitals across the state to improve access to maternal‐fetal medicine (MFM) specialist care.
METHODS: 24 qualitative in‐depth interviews were conducted with clinicians and telemedicine experts during July‐September 2020. Perspectives from 12 Level I/II and both Level IV birthing hospitals were represented.
Method: Survey/Qualitative
Classification of Research: Access to Care
Results: Less than half of lower‐level hospitals currently offer obstetric services through telemedicine. Both Level IV hospitals have interest and technical capacity to support implementation of a PTM network in Maryland. However, perceived barriers to patient adoption of PTM were access to technology, IT literacy, and language. Perceived barriers to provider adoption of PTM services included hospital leadership buy‐in, information technology (IT) literacy, and patient triage complexities. Influential factors for implementing a PTM network in Maryland included buy‐in and approval from hospital and health system administration, a streamlined and integrated telehealth platform, and sustained program funding.
Conclusions: Gaps in availability of maternal fetal medicine care at lower level birthing hospitals call for expanded telehealth services to improve high‐risk patients’ access to specialty obstetric care and support the development of a perinatal telemedicine and telementoring network in Maryland.
14. PIVOTING PRO BONO CARE FROM ON‐SITE TO VIRTUAL: PREVENTING DECLINE AND ADDRESSING FALL RISK
Aimee Perron, Jane Baldwin
Mass General Brigham IHP
Description: The MGH Institute of Health Professions IMPACT Practice Center (IPC), a pro bono center providing clinical education and accessible care to community clients has either been closed or at limited capacity restrictions. Early in 2020, the IPC immediately shifted its attention to telepractice.
Abstract: The impact of the pandemic on society, health care, and education has left no one unaffected. The MGH Institute of Health Professions IMPACT Practice Center (IPC), a pro bono center providing student clinical experiences and accessible care to community clients has either been closed or at limited capacity restrictions. Many of the center clients who are limited by health disparities and reduced access to care now had higher risk for falls and functional decline. Early in 2020, the IPC immediately shifted its attention to telepractice as a means of providing clinical education enabling continued student progression and ongoing care for clients in need.
IPC faculty researched telepractice regulations and accreditation criteria. Consent forms, faculty and student telepractice guides and training, and student outcome measures were developed. Within 10 days of the onsite Center’s closure, students and community clients were participating in individual and group virtual visits and continued success has been sustained.
While the IPC’s story is unique to the IHP, we have identified foundational components that facilitated its successful telepractice pivot including leadership and team development on both the faculty and students.
Method: Survey/Qualitative
Classification of Research: Access to Care
Results: completed a pre/post telepractice Skills Self‐Efficacy Scale. Students improved in most areas with the greatest improvements seen in rapport, communication, and consideration of client needs and values. Client satisfaction surveys demonstrated the greatest satisfactions in goal attainment and therapy expectations. Retrospective case reviews of pre and post outcome measures demonstrated sustained functional performance and reduced fall risk.
Conclusions: This quick, but deliberate shift allowed students to continue developing clinical competencies while adding telepractice skills and allowed our most vulnerable clients to at minimum sustain their function and have access to social connections. Although it may have taken a pandemic to do so, the physical therapy education community is examining, dissecting, and discussing our traditional educational practices and examining alternative methods of educating the future generations of physical therapists and physical therapist assistants.
15. TEETH‐BONES TALKS : TELECONSULTATION PLATFORM AS AN EFFECTIVE TOOL FOR THE TREATMENT AND PREVENTION OF OSTEONECROSIS OF THE JAW OF OSTEOPOROSIS PATIENTS IN DENTISTRY
Namki Hong, Wonse Park, Yiseul Choi, Yumie Rhee
Yonsei University College of Dentistry
Description: The purpose of this study is to evaluate the effectiveness of teleconsultation for osteoporosis treatment and ONJ prevention using a teleconsultation platform targeting osteoporosis patients. For this purpose, the efficiency of teleconsultation between dentists and physicians and between primary and secondary cares were evaluated by randomized controlled trials
Abstract: Osteoporosis is an increasing trend worldwide, and the most serious side effect of antiresorptive medications in osteoporosis is osteonecrosis of jaw (ONJ). However, it is difficult to treat and prevent ONJ due to the communication problem between dentists and physicians. To solve these problems, physicians and dentists must share essential information, and should be able to make quick and appropriate judgements about the queries and communicate them efficiently to each other.
The clinical efficacy of Teeth‐Bones Talks (TBT), a teleconsultation platform targeting ONJ prevention and treatment, was evaluated in dental treatment for osteoporosis patients. To evaluate the effectiveness, two clinical studies were conducted: a clinical study in which teleconsultation between a dentist and an physician and a teleconsultation between primary and secondary care were conducted. In both clinical studies, the time required for confirmation and completion of consultation, and the patient’s cost of treatment, were compared with those of usual consultation. In addition, a survey was conducted on teleconsultation among patients and health providers who participated in the clinical study.
Method: Randomized Controlled Trial
Classification of Research: Clinical Outcomes
Results: Both the checked time and the completion time of the consultation were significantly reduced during the teleconsultation between the dentist and the physician. Although the patient’s treatment cost decreased, there was no significant difference.
In addition, Both the checked time and the completion time of the consultation between primary care and secondary care were significantly shortened compared to the usual consultation. The patient’s treatment cost also decreased with a significant difference.
Patients and health providers were highly satisfied with the teleconsultation, and the biggest advantage of teleconsultation was speed, and the disadvantage was misdiagnosis.
Conclusions: Through this study, the clinical effectiveness of teleconsultation was confirmed, and it was confirmed that communication between dentists and physicians was improved by using teleconsultation during dental treatment of osteoporosis patients.
In a situation where the demand for non‐face‐to‐face medical care is increasing due to a pandemic such as COVID‐19, teleconsultation of dentistry is expected to be an effective tool to increase the clinical efficiency of the patients and health providers.
16. THE RELATIONSHIP BETWEEN INCOME, INSURANCE STATUS, AND AFFORDABILITY AS MOTIVATION FOR PATIENTS’ USE OF CASH‐PAY TELEHEALTH SERVICES
Lauren Broffman
Ro
Description: Removing access barriers is a potential benefit of telehealth. Direct‐to‐consumer telehealth companies offering cash‐pay services may be particularly well‐suited to increase access for lower income or uninsured patients. However, little is known about whether affordability is a motivating factor for utilization among these populations.
Abstract: This study explored the relationship between income, insurance status, and affordability as a motivation for patients’ use of cash‐pay telehealth services. The study analyzed survey data collected from a random sample of patients receiving treatment on a cash‐pay telehealth platform in 2020, including relevant demographic information regarding patients’ self‐reported insured status and income. Patients also indicated to what extent the agreed with the statement “I used the platform because it was affordable.” Most (72.6%) patients were privately insured, and 12.6% were uninsured, a larger‐than‐expected number compared to nationwide coverage rates. Another 16.4% of respondents reported Medicaid or Medicare insurance. One‐quarter of respondents reported an annual household income of under $50,000, half reported an annual income between $50,000‐$75,000, and one‐quarter reported annual income over $75,000, suggesting that the population’s income might be only slightly higher than the nationwide median (approximately $67,500 in 2020). Chi square tests of association showed lower income and uninsured patients were significantly more likely to agree they sought care on the platform because it was affordable, suggesting cash‐pay telehealth might serve as an accessible option for patients lacking insurance coverage or experiencing financial limitations.
Method: Survey/Qualitative
Classification of Research: Access to Care
Results: Of patients using cash‐pay telehealth services, those reporting lower incomes were somewhat more likely to agree they used the platform for affordability reasons: 75.6% of patients with a yearly household income of under $50,000 vs. 64.9% with incomes betweens $50,000 and $75,000 and 62.6% with incomes over $75,000 a year (2 = 4.75, p = .093). Uninsured patients were significantly more likely to agree they used the platform for affordability reasons: 83.7% of uninsured vs. 64.9% of privately insured and 61.0% of patients with Medicaid/Medicare (2 = 7.60, p = .022).
Conclusions: Uninsured and lower‐income patients of a cash‐pay telehealth service were more likely to report using the platform for affordability reasons than patients with coverage and with higher household incomes. Results suggest that for patients experiencing insurance coverage or financial‐related access limitations, these platforms are a viable pathway to care.
17. USE OF LONG‐ACTING ANTIPSYCHOTIC TREATMENTS IN COMMUNITY TELEPSYCHIATRY: STUDY TO ASSESS KNOWLEDGE, ATTITUDES, AND PERCEIVED BARRIERS FROM PATIENTS’, CAREGIVERS’, AND PROVIDERS’ PERSPECTIVES IN SOUTH CAROLINA (LATITUDE STUDY)
Amanda Pollak, Amy Claxton, Batool A. Haider, Brittany D. Roy, Casey Childers, Cory Saucier, Elizabeth Keane, Meera Narasimhan, Sergey Yagoda, Suzanne Hardeman
Prisma Health‐USC Medical Group. University of South Carolina‐Columbia
Description: This cross‐sectional, noninterventional study will assess existing perceptions and knowledge of LAI antipsychotics in the treatment of patients with serious mental illness (SMI; schizophrenia, schizoaffective disorder, or bipolar I disorder) in the community telepsychiatry model of care.
Abstract: In South Carolina, shortages of mental health practitioners prompted the Department of Mental Health to institute an Emergency Department Telepsychiatry Program (EDTP) in 2007 and a Community Telepsychiatry Program (CTP) in 2013. In‐person administration requirements of LAI antipsychotics may add barriers to their use in conjunction with telepsychiatry, despite the known utility of these agents in the schizophrenia treatment paradigm. LATITUDE is an ongoing study of knowledge of, attitudes toward, and perceived barriers to utilizing LAI antipsychotics for schizophrenia in telepsychiatry. All study materials were created using community‐based participatory research principles. LATITUDE uses quantitative online surveys of EDTP and CTP psychiatrists and qualitative interviews with CTP psychiatrists, clinicians (nurses, case workers), and adult caregivers of people with SMI. LATITUDE also includes focus groups of adults with schizophrenia prescribed antipsychotics within the past 2 years. Interviews and focus groups will be audio‐recorded once consent is provided. Deidentified transcripts will be coded using content thematic analysis in accordance with grounded theory analysis methods. Emerging themes and subthemes will be developed for each participant group (CTP, clinicians, caregivers, and patients). The quantitative and qualitative studies will also evaluate the impact of the COVID‐19 pandemic on LAI use and the telepsychiatry care model.
Method: Survey/Qualitative, Descriptive, Other
Classification of Research: Access to Care, Patient Experience, Clinician Experience
Results: The LATITUDE study aims to characterize the attributes and experiences of telepsychiatry physicians, as well as to assess the attitudes and perceived barriers to implementing LAI antipsychotics in the treatment of patients with schizophrenia in a telepsychiatry setting. LATITUDE will also include qualitative interviews and focus groups that aim to assess participant characteristics and knowledge of, attitudes toward, and barriers to LAI antipsychotic use.
Conclusions: LATITUDE is designed to assess knowledge, attitudes, and barriers regarding LAI antipsychotic use in telepsychiatry from the entire treatment team, including telepsychiatry clinical staff, caregivers, and patients. In this way, the quantitative and qualitative data collected in LATITUDE may offer a unique perspective that complements results obtained from clinical studies.