Evaluation of an Intrahospital Telemedicine Program for Patients Admitted With COVID-19: Mixed Methods Study.
COVID-19
communication
evaluation
exposure
hospital
hospital medicine
impact
mixed methods
risk
telehealth
telemedicine
Journal
Journal of medical Internet research
ISSN: 1438-8871
Titre abrégé: J Med Internet Res
Pays: Canada
ID NLM: 100959882
Informations de publication
Date de publication:
29 04 2021
29 04 2021
Historique:
received:
23
11
2020
accepted:
11
04
2021
revised:
30
01
2021
pubmed:
20
4
2021
medline:
19
5
2021
entrez:
19
4
2021
Statut:
epublish
Résumé
The increasing incidence of COVID-19 infection has challenged health care systems to increase capacity while conserving personal protective equipment (PPE) supplies and minimizing nosocomial spread. Telemedicine shows promise to address these challenges but lacks comprehensive evaluation in the inpatient environment. The aim of this study is to evaluate an intrahospital telemedicine program (virtual care), along with its impact on exposure risk and communication. We conducted a natural experiment of virtual care on patients admitted for COVID-19. The primary exposure variable was documented use of virtual care. Patient characteristics, PPE use rates, and their association with virtual care use were assessed. In parallel, we conducted surveys with patients and clinicians to capture satisfaction with virtual care along the domains of communication, medical treatment, and exposure risk. Of 137 total patients in our primary analysis, 43 patients used virtual care. In total, there were 82 inpatient days of use and 401 inpatient days without use. Hospital utilization and illness severity were similar in patients who opted in versus opted out. Virtual care was associated with a significant reduction in PPE use and physical exam rate. Surveys of 41 patients and clinicians showed high rates of recommendation for further use, and subjective improvements in communication. However, providers and patients expressed limitations in usability, medical assessment, and empathetic communication. In this pilot natural experiment, only a subset of patients used inpatient virtual care. When used, virtual care was associated with reductions in PPE use, reductions in exposure risk, and patient and provider satisfaction.
Sections du résumé
BACKGROUND
The increasing incidence of COVID-19 infection has challenged health care systems to increase capacity while conserving personal protective equipment (PPE) supplies and minimizing nosocomial spread. Telemedicine shows promise to address these challenges but lacks comprehensive evaluation in the inpatient environment.
OBJECTIVE
The aim of this study is to evaluate an intrahospital telemedicine program (virtual care), along with its impact on exposure risk and communication.
METHODS
We conducted a natural experiment of virtual care on patients admitted for COVID-19. The primary exposure variable was documented use of virtual care. Patient characteristics, PPE use rates, and their association with virtual care use were assessed. In parallel, we conducted surveys with patients and clinicians to capture satisfaction with virtual care along the domains of communication, medical treatment, and exposure risk.
RESULTS
Of 137 total patients in our primary analysis, 43 patients used virtual care. In total, there were 82 inpatient days of use and 401 inpatient days without use. Hospital utilization and illness severity were similar in patients who opted in versus opted out. Virtual care was associated with a significant reduction in PPE use and physical exam rate. Surveys of 41 patients and clinicians showed high rates of recommendation for further use, and subjective improvements in communication. However, providers and patients expressed limitations in usability, medical assessment, and empathetic communication.
CONCLUSIONS
In this pilot natural experiment, only a subset of patients used inpatient virtual care. When used, virtual care was associated with reductions in PPE use, reductions in exposure risk, and patient and provider satisfaction.
Identifiants
pubmed: 33872187
pii: v23i4e25987
doi: 10.2196/25987
pmc: PMC8086788
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e25987Subventions
Organisme : AHRQ HHS
ID : K12 HS026379
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR002492
Pays : United States
Organisme : AHRQ HHS
ID : R01 HS026732
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002494
Pays : United States
Informations de copyright
©Sean Legler, Matthew Diehl, Brian Hilliard, Andrew Olson, Rebecca Markowitz, Christopher Tignanelli, Genevieve B Melton, Alain Broccard, Jonathan Kirsch, Michael Usher. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 29.04.2021.
Références
Aten Primaria. 2020 Jun - Jul;52(6):418-422
pubmed: 32402477
Syst Rev. 2017 Jul 3;6(1):128
pubmed: 28673333
J Med Syst. 2020 May 28;44(7):125
pubmed: 32462352
J Med Syst. 2020 Jun 15;44(7):132
pubmed: 32542571
N Engl J Med. 2020 May 21;382(21):2005-2011
pubmed: 32220208
Intern Med. 2007;46(5):227-32
pubmed: 17329917
Camb Q Healthc Ethics. 2008 Fall;17(4):417-28
pubmed: 18724881
JAMA Intern Med. 2020 Oct 1;180(10):1389-1391
pubmed: 32744593
Patient Educ Couns. 2009 Mar;74(3):339-46
pubmed: 19124216
Int J Med Inform. 2008 Jul;77(7):486-98
pubmed: 18023610
J Am Acad Orthop Surg. 2020 Jun 1;28(11):e469-e476
pubmed: 32301818
Emerg Med J. 2020 Jun;37(6):335-337
pubmed: 32366616
BMJ. 2020 Mar 12;368:m998
pubmed: 32165352
J Gen Intern Med. 2020 Jul;35(7):2136-2145
pubmed: 31898116
Lancet. 2020 Apr 11;395(10231):1225-1228
pubmed: 32178769
Med Care. 2009 Jun;47(6):626-33
pubmed: 19433995
Anaesthesia. 2020 Jul;75(7):920-927
pubmed: 32246849
Psychol Serv. 2012 May;9(2):111-131
pubmed: 22662727
J Hosp Med. 2018 Sep 26;13(11):759-763
pubmed: 30255859
JAMA. 2020 Mar 17;323(11):1061-1069
pubmed: 32031570
J Pain Symptom Manage. 2020 Jul;60(1):e12-e14
pubmed: 32240756
N Engl J Med. 2020 Apr 30;382(18):1679-1681
pubmed: 32160451
Int J Telemed Appl. 2014;2014:143824
pubmed: 25243009
Am J Pharm Educ. 2016 May 25;80(4):58
pubmed: 27293225
Digit Health. 2019 Apr 23;5:2055207619845831
pubmed: 31069105
J Crit Care. 2013 Jun;28(3):315.e1-12
pubmed: 23159139