Application of the Quadruple Aim to evaluate the operational impact of a telemedicine program.


Journal

Healthcare (Amsterdam, Netherlands)
ISSN: 2213-0772
Titre abrégé: Healthc (Amst)
Pays: Netherlands
ID NLM: 101622189

Informations de publication

Date de publication:
Dec 2021
Historique:
received: 14 01 2021
revised: 20 10 2021
accepted: 26 10 2021
pubmed: 9 11 2021
medline: 15 12 2021
entrez: 8 11 2021
Statut: ppublish

Résumé

In response to the COVID-19 pandemic, telemedicine utilization has increased dramatically, yet most institutions lack a standardized approach to determine how much to invest in these programs. We used the Quadruple Aim to evaluate the operational impact of CardioClick, a program replacing in-person follow-up visits with video visits in a preventive cardiology clinic. We examined data for 134 patients enrolled in CardioClick with 181 video follow-up visits and 276 patients enrolled in the clinic's traditional prevention program with 694 in-person follow-up visits. Patients in CardioClick and the cohort receiving in-person care were similar in terms of age (43 vs 45 years), gender balance (74% vs 79% male), and baseline clinical characteristics. Video follow-up visits were shorter than in-person visits in terms of clinician time (median 22 vs 30 min) and total clinic time (median 22 vs 68 min). Video visits were more likely to end on time than in-person visits (71 vs 11%, p < .001). Physicians more often completed video visit documentation on the day of the visit (56 vs 42%, p = .002). Implementation of video follow-up visits in a preventive cardiology clinic was associated with operational improvements in the areas of efficiency, patient experience, and clinician experience. These benefits in three domains of the Quadruple Aim justify expanded use of telemedicine at our institution. The Quadruple Aim provides a framework to evaluate telemedicine programs recently implemented in many health systems. Level III (retrospective comparative study).

Sections du résumé

BACKGROUND BACKGROUND
In response to the COVID-19 pandemic, telemedicine utilization has increased dramatically, yet most institutions lack a standardized approach to determine how much to invest in these programs.
METHODS METHODS
We used the Quadruple Aim to evaluate the operational impact of CardioClick, a program replacing in-person follow-up visits with video visits in a preventive cardiology clinic. We examined data for 134 patients enrolled in CardioClick with 181 video follow-up visits and 276 patients enrolled in the clinic's traditional prevention program with 694 in-person follow-up visits.
RESULTS RESULTS
Patients in CardioClick and the cohort receiving in-person care were similar in terms of age (43 vs 45 years), gender balance (74% vs 79% male), and baseline clinical characteristics. Video follow-up visits were shorter than in-person visits in terms of clinician time (median 22 vs 30 min) and total clinic time (median 22 vs 68 min). Video visits were more likely to end on time than in-person visits (71 vs 11%, p < .001). Physicians more often completed video visit documentation on the day of the visit (56 vs 42%, p = .002).
CONCLUSIONS CONCLUSIONS
Implementation of video follow-up visits in a preventive cardiology clinic was associated with operational improvements in the areas of efficiency, patient experience, and clinician experience. These benefits in three domains of the Quadruple Aim justify expanded use of telemedicine at our institution.
IMPLICATIONS CONCLUSIONS
The Quadruple Aim provides a framework to evaluate telemedicine programs recently implemented in many health systems.
LEVEL OF EVIDENCE METHODS
Level III (retrospective comparative study).

Identifiants

pubmed: 34749227
pii: S2213-0764(21)00076-2
doi: 10.1016/j.hjdsi.2021.100593
pmc: PMC8570264
mid: NIHMS1754717
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

100593

Subventions

Organisme : NHLBI NIH HHS
ID : K01 HL144607
Pays : United States
Organisme : AHRQ HHS
ID : T32 HS026128
Pays : United States

Informations de copyright

Copyright © 2021 Elsevier Inc. All rights reserved.

Auteurs

Neil M Kalwani (NM)

Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA.

Katherine M Wang (KM)

Division of Nephrology, Stanford University School of Medicine, Stanford, CA, USA.

Austin N Johnson (AN)

Stanford University School of Medicine, Stanford, CA, USA.

Jahnavi D Deb (JD)

Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.

Thomas Gold (T)

Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.

Akhil K Maddukuri (AK)

Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.

Emily G Savage (EG)

Stanford Graduate School of Business, Stanford, CA, USA.

Vijaya Parameswaran (V)

Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.

Rajesh Dash (R)

Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.

David Scheinker (D)

Department of Management Science and Engineering, Stanford University, Stanford, CA, USA; Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.

Fatima Rodriguez (F)

Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: frodrigu@stanford.edu.

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Classifications MeSH