Patient and Health System Experience With Implementation of an Enterprise-Wide Telehealth Scheduled Video Visit Program: Mixed-Methods Study.

BACKGROUND: Real-time video visits are increasingly used to provide care in a number of settings because they increase access and convenience of care, yet there are few reports of health system experiences. OBJECTIVE: The objective of this study is to report health system and patient experiences with implementation of a telehealth scheduled video visit program across a health system. METHODS: This is a mixed methods study including (1) a retrospective descriptive report of implementation of a telehealth scheduled visit program at one large urban academic-affiliated health system and (2) a survey of patients who participated in scheduled telehealth visits. Health system and patient-reported survey measures were aligned with the National Quality Forum telehealth measure reporting domains of access, experience, and effectiveness of care. RESULTS: This study describes implementation of a scheduled synchronous video visit program over an 18-month period. A total of 3018 scheduled video visits were completed across multiple clinical departments. Patient experiences were captured in surveys of 764 patients who participated in telehealth visits. Among survey respondents, 91.6% (728/795) reported satisfaction with the scheduled visits and 82.7% (628/759) reported perceived quality similar to an in-person visit. A total of 86.0% (652/758) responded that use of the scheduled video visit made it easier to get care. Nearly half (46.7%, 346/740) of patients estimated saving 1 to 3 hours and 40.8% (302/740) reported saving more than 3 hours of time. The net promoter score, a measure of patient satisfaction, was very high at 52. CONCLUSIONS: A large urban multihospital health system implemented an enterprise-wide scheduled telehealth video visit program across a range of clinical specialties with a positive patient experience. Patients found use of scheduled video visits made it easier to get care and the majority perceived time saved, suggesting that use of telehealth for scheduled visits can improve potential access to care across a range of clinical scenarios with favorable patient experiences

21st Century Cures Act: Patient Perceptions on Open Information Sharing in Vermont Primary Care Clinics

Introduction: The 21st Century Cures Act federally mandated the release of progress notes, laboratory test results, and radiology/pathology reports to the patient’s electronic health record (EHR) portal. This study investigates patient perspectives on shared notes and addresses provider concerns about patient uptake due to potential factors like worry, confusion, and distress at the University of Vermont Medical Center. Materials and Methods: An electronic cross-sectional survey was designed and distributed to 7,240 eligible patients, adults who logged into MyChart on Epic and had an outpatient/telemedical visit at either the Colchester Family Medicine and South Burlington Primary Care locations in Vermont within one year prior to the study. Results: The survey response rate was 4.6%. Of the respondents, 90% agreed that the use of shared notes is a good idea, 76% found accessing notes easy, and 2% felt more worried about their health because of shared notes. 89%, 85%, and 82% of respondents found visit notes important for understanding their health, remembering their care plan, and feeling in control of their care, respectively. Conclusions: Based on this survey, provider concerns about patient stress may be overstated, as patients appear to benefit from shared notes through increased engagement with their health, communication with providers, and adherence to care plans

Histological Changes of Bronchopulmonary Dysplasia and Pulmonary Hypertension: An Autopsy Series of 42 Preterm Infants

Background: Bronchopulmonary Dysplasia (BPD), a significant cause of perinatal morbidity and mortality, leads to disrupted pulmonary vascular growth and ultimately pulmonary hypertension (PH). The diagnosis of BPD is made by oxygen requirement for at least first 28 days of life. We hypothesized that histologic changes of BPD are evident before 28 days of age. Methods: All live born preterm infants born \u3c37 weeks of gestational age (GA), who received an autopsy between 2010 and 2017 at Children’s Hospital of Michigan or Hutzel Women’s Hospital, were identified by autopsy records. Infants with major congenital defects were excluded. Clinical data were extracted from electronic medical records. Autopsy specimens of lung and heart tissue were examined by a single pathologist, and classified according to presence or absence of defining features of BPD and PH. Results: Of the 42 preterm infants that met the study criteria, 79% were \u3c32 weeks GA, 55% were male, 55% were African American, 33% were SGA, and 17% were twins. Infants that died at \u3c28 days of life were statistically more likely to be African American and receiving high frequency ventilation and were less likely to have preterm premature rupture of membranes (PPROM) and an echocardiogram obtained as part of their clinical workup. Of infants \u3c32 weeks GA, 61% died at \u3c28 days of age; histological BPD was observed in 25% of infants and PH was observed in 65%. Of infants \u3c32 weeks GA, 39% died at ≥28 days; histological BPD was observed in 92% and histological PH was observed in 85% of subjects. Of infants ≥32 weeks GA, 78% died at \u3c28 days of age; histological BPD was observed in 0% of infants and PH was observed in 71%. Of infants ≥32 weeks GA, 22% died at ≥28 days; histological BPD and PH were both observed in 50% of subjects. Histological changes of BPD observed in 5 infants born \u3c32 weeks GA who died before 28 days of age were identified as early as 6.73 days of age. Histologic PH was identified in 4 of the 5 infants with the earliest evidence being observed in an infant that died at 6.73 days of age. Conclusion: Histologic changes consistent with BPD and PH were evident in 25% and 65% respectively of postmortem lung samples from infants born \u3c32 weeks GA who received less than 28 days of cumulative oxygen support. These findings suggest that there is a need to develop better clinical criteria and dedicate future research to seeking biomarkers for BPD in extremely preterm infants before 32 weeks GA. Because timely intervention is key to minimizing long-term effects of the disease, research that further refines the timeline of BPD’s pathogenesis is essential. By identifying infants at risk through reliable biomarkers and initiating preventative measures before 28 days of life, clinicians may prevent long-term morbidity and mortality related to BPD

Maximizing ENSO as a source of western US hydroclimate predictability

Until recently, the El Niño–Southern Oscillation (ENSO) was considered a reliable source of winter precipitation predictability in the western US, with a historically strong link between extreme El Niño events and extremely wet seasons. However, the 2015–2016 El Niño challenged our understanding of the ENSO-precipitation relationship. California precipitation was near-average during the 2015–2016 El Niño, which was characterized by warm sea surface temperature (SST) anomalies of similar magnitude compared to the extreme 1997–1998 and 1982–1983 El Niño events. We demonstrate that this precipitation response can be explained by El Niño’s spatial pattern, rather than internal atmospheric variability. In addition, observations and large-ensembles of regional and global climate model simulations indicate that extremes in seasonal and daily precipitation during strong El Niño events are better explained using the ENSO Longitude Index (ELI), which captures the diversity of ENSO’s spatial patterns in a single metric, compared to the traditional Niño3.4 index, which measures SST anomalies in a fixed region and therefore fails to capture ENSO diversity. The physically-based ELI better explains western US precipitation variability because it tracks the zonal shifts in tropical Pacific deep convection that drive teleconnections through the response in the extratropical wave-train, integrated vapor transport, and atmospheric rivers. This research provides evidence that ELI improves the value of ENSO as a predictor of California’s seasonal hydroclimate extremes compared to traditional ENSO indices, especially during strong El Niño events