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

Quality Improvement for the JeffMD Clinical Experience Program

Introduction: The JeffMD curriculum at Sidney Kimmel Medical College, which completed its inaugural year in the spring of 2018, aims to prepare future physicians to “thrive in the landscape of modern healthcare.” The curriculum is based upon the knowledge that human health exists interdependently with all aspects of life, including but not limited to social, health care system, behavioral, and biological factors. The JeffMD Clinical Experience Program (CE) is a mandatory, experiential, value-added component of the curriculum. Through the CE course, which spans the 21-month preclinical period, students work with a Community Health Worker to screen patients for social needs and connect them to community resources. Objective: The purpose of this Quality Improvement study was twofold. First, we sought to evaluate the extent to which the first year of the CE program (1) contributed to student learning, and (2) added value to the clinical sites. Second, we sought to implement site-specific improvements based upon our results. Methods: We followed the Plan-Do-Study-Act (PDSA) model. We measured the current performance of the CE program through electronic surveys administered to the 260 first-year medical students who participated. The surveys included free response and Likert scale questions. We also conducted small group interviews with key stakeholders from four of the clinical sites using a questionnaire adapted from Penn State. Results: Students valued the opportunity to interact with patients and learn about social determinants of health; however, they did not find the CE program to be an effective learning experience. Key themes from the clinical site interviews included lack of student initiative, physical space constraints, communication barriers, and the positive contribution of Community Health Workers. Conclusion: We performed cause analyses and implemented clinical site-specific changes based upon our results. We believe that the student experience will improve from year-to-year so long as we continue to incorporate feedback from students and other stakeholders

Patient Perception of Telehealth Primary Care Video Visits

Introduction Telehealth (TH) is an innovative model of care delivery with potential to provide more patient-centered healthcare, allowing patients to receive care when and where is most convenient. To date, little is known about patient perceptions of receiving care with the use of TH video visits.https://jdc.jefferson.edu/medposters/1002/thumbnail.jp

Understanding Patient Uncertainty as a Driver of Emergency Department Utilization: A Concept Mapping Approach

Background and Purpose Most previous research regarding factors associated with increased risk of emergency department (ED) use has been done via retrospective review of medical records rather than obtaining patients’ perspectives. Recent research identified patient uncertainty related to symptoms as a primary motivator for seeking ED care, and ongoing uncertainty at the time of ED discharge as an unmet need (Rising et al. 2015; Rising, Hudgins, Reigle, Hollander, & Carr 2016). While providers have limited ability to influence many factors identified by retrospective medical record review (e.g. financial concerns), patient uncertainty can be addressed by providers directly. To do so we must first define domains of uncertainty that patients experience in order to inform targeted interventions to address patient uncertainty. The objective of this research was to engage patients through group concept mapping (GCM) to conceptualize the domains of uncertainty that contribute to decisions to seek care in the ED.https://jdc.jefferson.edu/emposters/1000/thumbnail.jp