Cardiac Outpatient Care in a Digital Age: Remote Cardiology Clinic Visits in the Era of COVID-19

QUALITY CARE ANALYSIS OF THE APPROPRIATENESS OF VETERANS AFFAIRS CARDIOLOGY CLINIC VISITS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)33627-7 ◽

2019 ◽

Vol 73 (9) ◽

pp. 3021

Author(s):

Ayush Motwani ◽

Karnika Ayinapudi ◽

Twinkle Singh ◽

Mark Cassidy ◽

Anand Irimpen

Keyword(s):

Quality Care ◽

Veterans Affairs ◽

Cardiology Clinic ◽

Clinic Visits

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Taking prevention to the next step: implementation of a brief, sustainable frailty assessment in a cardiology clinic

BMJ Open Quality ◽

10.1136/bmjoq-2020-001140 ◽

2021 ◽

Vol 10 (1) ◽

pp. e001140

Author(s):

Ariela R Orkaby ◽

Kirstyn James ◽

Jessica Leuchtenburg ◽

Esther Solooki ◽

J Michael Gaziano ◽

...

Keyword(s):

Older Adults ◽

Electronic Health Record ◽

Gait Speed ◽

Health Record ◽

Speed Measurement ◽

Frailty Assessment ◽

Cardiology Clinic ◽

Electronic Health ◽

Usual Gait Speed ◽

Clinic Visits

BackgroundFrailty measurement is recommended when assessing older adults with cardiovascular disease to individualise prevention and treatment. We sought to address this by incorporating routine gait speed measurement by clinicians into an outpatient preventive cardiology clinic.MethodsQuality improvement (QI) project initiated at VA Boston in January 2015 to measure usual gait speed in m/s over a 4 m distance for patients aged 70 and older. The primary outcome was completion and documentation of 4 m usual gait speed. Data were manually extracted from the electronic health record. Frequency distributions and descriptive statistics are presented.InterventionsSeveral change interventions were implemented over a 5-year period (January 2015–December 2019) addressing (1) stakeholder engagement and project champions, (2) staff education, (3) assessment space, (4) electronic health record template update and (5) sustaining the initiative. Statistical process control charts were used to monitor proportion of gait speed measurement and to detect shifts resulting from 5 phase change interventions.ResultsDuring this QI project, 178 patients aged 70 and older attended the clinic, accounting for 1042 individual clinic visits. Gait speed was measured at least once for 157 patients; 21 were never assessed. At the end of the first month (January 2015), gait speed was measured during 40% of clinic visits and rose to a median measurement rate of 78% at clinic visits during the 2018–2019 study period. An unanticipated result was the spread of the initiative to other cardiology clinics.ConclusionsGait speed measurement was successfully embedded into clinic assessments for older adults at a cardiology clinic following targeted interventions. This project highlights the feasibility of incorporating a brief frailty assessment such as gait speed, into non-geriatric medicine clinics.

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INNOVATIONS IN TELEMEDICINE SERVICES IN SPINA BIFIDA CLINICS IN THE U.S. DURING THE COVID-19 PANDEMIC

Technology & Innovation ◽

10.21300/22.2.2021.4 ◽

2021 ◽

Author(s):

Brad E. Dicianno ◽

Hubert S. Swana ◽

Rory A. Cooper ◽

Timothy J. Brei

Keyword(s):

Spina Bifida ◽

Outpatient Care ◽

Multidisciplinary Clinic ◽

The Impact ◽

The U.S ◽

Clinic Visits

The COVID-19 pandemic has dramatically impacted delivery of outpatient care. Many people with spina bifida (SB) in the U.S. receive outpatient healthcare in a multidisciplinary setting. In accordance with state healthcare mandates, outpatient multidisciplinary clinic visits were deferred, postponed, or canceled, while telemedicine systems were implemented. A survey was created and distributed to all known SB clinics in the U.S. We explored the impact of the COVID-19 pandemic on the delivery of outpatient care for the SB population and the use oftelemedicine in response. Novel uses of telehealth, benefits of use, suggestions for overcoming barriers, and future opportunities are identified and discussed.

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