scholarly journals The COVID-19 pandemic shifted the Veterans Affairs System toward being a payer and virtual care provider: is it sustainable?

2021 ◽  
Author(s):  
Liam Rose ◽  
Linda Diem Tran ◽  
Steven M Asch ◽  
Anita Vashi
Keyword(s):  
Financial Incentives ◽  
Care Delivery ◽  
Data Extraction ◽  
Medical Personnel ◽  
Extraction Methods ◽  
Virtual Care ◽  
Large Expansion ◽  
Virtual Visits ◽  
The Difference ◽  
One Year

Objective: To examine how VA shifted care delivery methods one year into the pandemic. Study Setting: All encounters paid or provided by VA between January 1, 2019 and February 27, 2021. Study Design: We aggregated all VA paid or provided encounters and classified them into community (non-VA) acute and non-acute visits, VA acute and non-acute visits, and VA virtual visits. We then compared the number of encounters by week over time to pre-pandemic levels. Data Extraction Methods: Aggregation of administrative VA claims and health records. Principal Findings: VA has experienced a dramatic and persistent shift to providing virtual care and purchasing care from non-VA providers. Before the pandemic, a majority (63%) of VA care was provided in-person at a VA facility. One year into the pandemic, in-person care at VA's constituted just 33% of all visits. Most of the difference made up by large expansions of virtual care; total VA provided visits (in person and virtual) declined (4.9 million to 4.2 million) while total visits of all types declined only 3.5%. Community provided visits exceeded prepandemic levels (2.3 million to 2.9 million, +26%). Conclusion: Unlike private health care, VA has resumed in-person care slowly at its own facilities, and more rapidly in purchased care with different financial incentives a likely driver. The very large expansion of virtual care nearly made up the difference. With a widespread physical presence across the U.S., this has important implications for access to care and future allocation of medical personnel, facilities, and resources.

scholarly journals Evaluation of Patient Experience During Virtual and In-Person Urgent Care Visits: Time and Cost Analysis

2021 ◽  
Vol 8 ◽  
pp. 237437352098148
Author(s):  
Saif Khairat ◽  
Xi Lin ◽  
Songzi Liu ◽  
Zhaohui Man ◽  
Tanzila Zaman ◽  
...  
Keyword(s):  
Patient Experience ◽  
Care Delivery ◽  
Turnaround Time ◽  
Cross Sectional Study ◽  
Emergency Department Visits ◽  
Urgent Care ◽  
Cross Sectional ◽  
Significant Difference ◽  
Virtual Visits ◽  
One Year

Urgent care (UC) is one of the fastest growing venues of health care delivery for nonemergent conditions. This study compared the patient experience during virtual and in-person urgent care visits. We conducted a cross-sectional study of patients with the same diagnosis during Virtual Urgent Care (VUC) and in-person UC visits with the same diagnosis with regard to time and cost over a period of one year. We recorded and analyzed 16 685 urgent care visits: In-person UC (n = 14 734), VUC (n = 1262). Significant differences were found in the average total time for a visit in an in-person UC (70.89 minutes), and VUC (9.38 minutes). The average total cost of VUC ($49) and in-person UC ($142.657) differed significantly. Significant difference was found between UC turnaround time and VC turnaround time (Dependent variable (DV): 53.77, P < .01). We found significant differences in cost and time between in favor of virtual visits. Our findings suggest additional policy reform to expand the use of virtual care among target populations to improve access, reduce costs, meet the needs of patients, and reduce emergency department visits.

scholarly journals Virtual Cancer Care During the COVID-19 Pandemic in Alberta: Evidence From a Mixed Methods Evaluation and Key Learnings

2021 ◽  
pp. OP.21.00144
Author(s):  
Linda Watson ◽  
Siwei Qi ◽  
Andrea Delure ◽  
Claire Link ◽  
Eclair Photitai ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Cancer Care ◽  
Large Scale ◽  
Care Delivery ◽  
Cancer Center ◽  
Mixed Methods Evaluation ◽  
Virtual Care ◽  
Patient Reported ◽  
Virtual Visits ◽  
The Impact

PURPOSE This study reports on a mixed methods evaluation conducted within a provincial cancer program in Alberta, Canada. The purpose was to capture key learnings from a rapid virtual care implementation because of the COVID-19 pandemic and to understand the impact on patient and staff experiences. METHODS Administrative data were collected for 21,362 patients who had at least one virtual or in-person visit to any provincial cancer center from April 1, 2020, to June 10, 2020. Patient surveys were conducted with 397 randomly selected patients who had received a virtual visit. Surveys were also conducted with 396 Cancer Care Alberta staff. RESULTS 14,906 virtual visits took place in this period, and about 40% of weekly visits were virtual. Significant differences were observed in both patient-reported symptom questionnaire completion rates and referrals to supportive care services between patients seen in-person and virtually. Patients receiving active treatments reported significantly lower levels of satisfaction with virtual visits than those seen for follow-up, but overall 90% of patients indicated interest in receiving virtual care in the future. Staff thought virtual visits increased patients' access to care but less than one third (31.5%) felt confident meeting patients' emotional needs and having conversations about disease progression and/or end of life virtually. CONCLUSION The COVID-19 pandemic has driven the rapid implementation of virtual visits for cancer care delivery in health care settings. The findings from this mixed methods evaluation provide a concrete set of considerations for organizations looking to develop a large-scale, enduring virtual care strategy.

scholarly journals 41 Innovative solutions to support “Virtual First” pediatric endocrine care

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e30-e30
Author(s):  
Ellen Goldbloom ◽  
Sarah Lawrence
Keyword(s):  
Health Care ◽  
Care Delivery ◽  
Family Needs ◽  
Pediatric Endocrinology ◽  
High Quality ◽  
Virtual Care ◽  
Innovative Solutions ◽  
Virtual Visits ◽  
Endocrinology Clinic

Abstract Primary Subject area Endocrinology and Metabolism Background With the onset of the SARS-CoV-2 pandemic, health care providers everywhere were forced to rapidly shift the way they deliver care. Within our community-based academic organization, there was variability in response to required changes among different clinical areas, with many clinics ramping down their services while they restructured. In our pediatric endocrinology clinic, we had built the infrastructure to support virtual care using a provincial platform as part of a pilot program for our diabetes population in the year preceding the pandemic. This experience set the stage for a swift pivot to virtual care. To ensure ongoing high quality consultation and follow-up services during the pandemic, our clinic required rapid restructuring to successfully and immediately shift completely to a sustainable “virtual first” approach in March 2020. Objectives In the months following the onset of the SARS-CoV-2 pandemic, we sought to quickly develop and implement innovative strategies, using a quality improvement framework, to supplement virtual care and maintain high quality care delivery. Design/Methods As soon as physical distancing measures were implemented in March 2020, our multidisciplinary team held daily 30-minute meetings to troubleshoot, brainstorm, and strategize potential adaptations in care delivery to ensure we continued to meet patient and family needs with primarily virtual care. Barriers and problems were presented and prioritized, solutions proposed, then implemented with support of operation and e-health teams. Attention to educational needs for medical students, residents and fellows helped shape solutions. Results The following innovative solutions were successfully implemented within three months: • a drive thru hemoglobin A1C clinic for patients with diabetes • a streamlined “low touch” Auxology Clinic to supplement virtual visits when body measurement, vital signs or physical exam assessment were required • pre-visit preparation instructions for patients and families • active promotion of patient portal enrolment • re-design of follow-up orders content to allow providers to accurately indicate suitability of virtual care alone or with support measures • a workflow to allow quick conversion from in-person to virtual visits to prevent cancellations related to isolation requirements • an educational framework to ensure level-appropriate exposure to and involvement in patient care for trainees • auto-faxing of medication and supplies • printer mapping and workflow for external lab requisitions • provider/staff scheduling and role re-assignment to facilitate minimal number of on-site staff • support of the team to adopt best practices for virtual visits Conclusion While virtual care delivery existed before the pandemic, it was rarely used outside of pilot projects, or only from necessity, when travel to a health care facility was not possible. Herein we provide an overview of an innovative, primarily virtual, care delivery model to satisfy patient and family needs in a pediatric endocrinology clinic in an academic centre. Many components of our model have (and can be) applied or adapted to support care delivery in other clinical areas. The people, processes, and digital health adaptations required to support a primarily virtual mode of care were critical to its success.

Unique views on obesity-related behaviors and environments: research using still and video images (Preprint)

2018 ◽  
Author(s):  
Jordan Carlson ◽  
J. Aaron Hipp ◽  
Jacqueline Kerr ◽  
Todd Horowitz ◽  
David Berrigan
Keyword(s):  
Physical Activity ◽  
Ethical Issues ◽  
Data Extraction ◽  
Dietary Assessment ◽  
Extraction Methods ◽  
Image Capture ◽  
Still Images ◽  
Key Informants ◽  
Technological Advances ◽  
Computer Scientists

BACKGROUND Image based data collection for obesity research is in its infancy. OBJECTIVE The present study aimed to document challenges to and benefits from such research by capturing examples of research involving the use of images to assess physical activity- or nutrition-related behaviors and/or environments. METHODS Researchers (i.e., key informants) using image capture in their research were identified through knowledge and networks of the authors of this paper and through literature search. Twenty-nine key informants completed a survey covering the type of research, source of images, and challenges and benefits experienced, developed specifically for this study. RESULTS Most respondents used still images in their research, with only 26.7% using video. Image sources were categorized as participant generated (N = 13; e.g., participants using smartphones for dietary assessment), researcher generated (N = 10; e.g., wearable cameras with automatic image capture), or curated from third parties (N = 7; e.g., Google Street View). Two of the major challenges that emerged included the need for automated processing of large datasets (58.8%) and participant recruitment/compliance (41.2%). Benefit-related themes included greater perspectives on obesity with increased data coverage (34.6%) and improved accuracy of behavior and environment assessment (34.6%). CONCLUSIONS Technological advances will support the increased use of images in the assessment of physical activity, nutrition behaviors, and environments. To advance this area of research, more effective collaborations are needed between health and computer scientists. In particular development of automated data extraction methods for diverse aspects of behavior, environment, and food characteristics are needed. Additionally, progress in standards for addressing ethical issues related to image capture for research purposes are critical. CLINICALTRIAL NA

Evaluating Virtual Care Experiences for Patients with Covid-19 Chief Complaints: Best-Practices Recommendations (Preprint)

2020 ◽  
Author(s):  
Saif Khairat ◽  
Malvika Pillai ◽  
Barbara Edson ◽  
Robert Gianforcaro
Keyword(s):  
Patient Experience ◽  
Wait Time ◽  
Secondary Outcome ◽  
Major Drawback ◽  
Cross Sectional ◽  
Average Wait Time ◽  
Adherence To Medication ◽  
Virtual Care ◽  
Chief Complaints ◽  
Virtual Visits

BACKGROUND Importance: Positive patient experiences are associated with illness recovery and adherence to medication. The shift toward virtual visits creates a need to understand the opportunities and challenges in providing a patient experience that is at least as positive as in-person visits. OBJECTIVE To evaluate the virtual care experience for patients with Covid-19 as their chief complaints. METHODS We conducted a cross-sectional study of the first cohort of patients with Covid-19 concerns in a virtual clinic. We collected data on all virtual visits between March 20-29, 2020. Outcomes: The main endpoints of this study were patient diagnosis, prescriptions received, referrals, wait time and duration, and satisfaction. The secondary outcome was the reported choice of alternative care options. RESULTS Of the 358 total virtual visits, 42 patients marked “Covid-19 Concern” as their chief complaint. Of those patients, 23 (54.8%) female patients, the average age of patients was 33.9 years, and 41 (97.7%) patients were seeking care for themselves and one (3.3%) visit was for a dependent. For all virtual visits, the average wait time (SD) was 157.2 (181.7) minutes and the average wait time (SD) for Covid-19 Concern visits was 177.4 (186.5) minutes. Covid-19 Concern phone visits had an average wait time (SD) of 180.1 (187.2), compared to 63.4 (34.4) minutes for Covid-19 Concern video visits. Thirteen (65%) patients rated their provider as “Excellent” with similar proportions among phone (64.3%) and video (66.7%). CONCLUSIONS This study evaluated the virtual experiences of patients with Covid-19 concerns. There were different experiences for patients depending on their choice of communication. Long wait times were a major drawback in the patient experience. We have learned from evaluating the experience of our first cohort of Covid-19 Concern patients.

scholarly journals Physician requirements for adoption of telehealth following the SARS-CoV-2 pandemic

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Michael Hodgkins ◽  
Meg Barron ◽  
Shireesha Jevaji ◽  
Stacy Lloyd
Keyword(s):  
Care Delivery ◽  
Virtual Technology ◽  
Privacy Concerns ◽  
Face To Face ◽  
House Calls ◽  
Care Delivery Model ◽  
Virtual Visits ◽  
Similar Survey ◽  
Remote Care

AbstractIt took the advent of SARS-CoV-2, a “black swan event”, to widely introduce telehealth, remote care, and virtual house calls. Prior to the epidemic (2019), the American Medical Association (AMA) conducted a routine study to compare physicians’ adoption of emerging technologies to a similar survey in 2016. Most notable was a doubling in the adoption of telehealth/virtual technology to 28% and increases in the use of remote monitoring and management for improved care (13–22%). These results may now seem insignificant when compared to the unprecedented surge in telehealth visits because of SARS-CoV-2. Even as this surge levels off and begins to decline, many observers believe we will continue to see a persistent increase in the use of virtual visits compared to face-to-face care. The requirements for adoption communicated by physicians in both the 2016 and 2019 surveys are now more relevant than ever: Is remote care as effective as in-person care and how best to determine when to use these modalities? How do I safeguard my patients and my practice from liability and privacy concerns? How do I optimize using these technologies in my practice and, especially integration with my EHR and workflows to improve efficiency? And how will a mix of virtual and in-person visits affect practice revenue and sustainability? Consumers have also expressed concerns about payment for virtual visits as well as privacy and quality of care. If telehealth and remote care are here to stay, continuing to track their impact during the current public health emergency is critically important to address so that policymakers and insurers will take necessary steps to ensure that the “new normal” will reflect a health care delivery model that can provide comparable or improved results today and into the future.

scholarly journals Ripeness Prediction of Postharvest Kiwifruit Using a MOS E-Nose Combined with Chemometrics

Sensors ◽  
2019 ◽  
Vol 19 (2) ◽  
pp. 419 ◽  
Author(s):  
Dongdong Du ◽  
Jun Wang ◽  
Bo Wang ◽  
Luyi Zhu ◽  
Xuezhen Hong
Keyword(s):  
Prediction Models ◽  
Extraction Methods ◽  
Oxide Semiconductor ◽  
Soluble Solids ◽  
Support Vector ◽  
Least Squares Regression ◽  
Accuracy Rate ◽  
Linear Discriminant ◽  
The Difference ◽  
Ripe Stage

Postharvest kiwifruit continues to ripen for a period until it reaches the optimal “eating ripe” stage. Without damaging the fruit, it is very difficult to identify the ripeness of postharvest kiwifruit by conventional means. In this study, an electronic nose (E-nose) with 10 metal oxide semiconductor (MOS) gas sensors was used to predict the ripeness of postharvest kiwifruit. Three different feature extraction methods (the max/min values, the difference values and the 70th s values) were employed to discriminate kiwifruit at different ripening times by linear discriminant analysis (LDA), and results showed that the 70th s values method had the best performance in discriminating kiwifruit at different ripening stages, obtaining a 100% original accuracy rate and a 99.4% cross-validation accuracy rate. Partial least squares regression (PLSR), support vector machine (SVM) and random forest (RF) were employed to build prediction models for overall ripeness, soluble solids content (SSC) and firmness. The regression results showed that the RF algorithm had the best performance in predicting the ripeness indexes of postharvest kiwifruit compared with PLSR and SVM, which illustrated that the E-nose data had high correlations with overall ripeness (training: R2 = 0.9928; testing: R2 = 0.9928), SSC (training: R2 = 0.9749; testing: R2 = 0.9143) and firmness (training: R2 = 0.9814; testing: R2 = 0.9290). This study demonstrated that E-nose could be a comprehensive approach to predict the ripeness of postharvest kiwifruit through aroma volatiles.

Open quantum system parameters for light harvesting complexes from molecular dynamics

2015 ◽  
Vol 17 (38) ◽  
pp. 25629-25641 ◽  
Author(s):  
Xiaoqing Wang ◽  
Gerhard Ritschel ◽  
Sebastian Wüster ◽  
Alexander Eisfeld
Keyword(s):  
Molecular Dynamics ◽  
Quantum System ◽  
Open Quantum System ◽  
Light Harvesting ◽  
Parameter Extraction ◽  
Extraction Methods ◽  
Light Harvesting Complexes ◽  
System Parameters ◽  
Open Quantum ◽  
The Difference

We elucidate the difference between various parameter extraction methods and demonstrate sensitivity to molecular dynamics equilibration.

scholarly journals Primary care teams’ experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rachelle Ashcroft ◽  
Catherine Donnelly ◽  
Maya Dancey ◽  
Sandeep Gill ◽  
Simon Lam ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Qualitative Study ◽  
Mental Health Care ◽  
Focus Groups ◽  
Care Delivery ◽  
Virtual Care ◽  
Primary Care Teams ◽  
The Impact

Abstract Background Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams’ delivery of mental health care. Methods A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. Results We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. Conclusions From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care’s capacity for mental health care for the duration of the pandemic and beyond.

Implementation of Web Application for Disease Prediction Using AI

2020 ◽  
pp. 5-9
Author(s):  
Manasvi Srivastava ◽  
◽  
Vikas Yadav ◽  
Swati Singh ◽  
◽  
...  
Keyword(s):  
Web Application ◽  
Ad Hoc ◽  
Data Extraction ◽  
Extraction Methods ◽  
Web Page ◽  
Web Based ◽  
Web Extraction ◽  
Web Scraping ◽  
Audio Video ◽  
Manual Extraction

The Internet is the largest source of information created by humanity. It contains a variety of materials available in various formats such as text, audio, video and much more. In all web scraping is one way. It is a set of strategies here in which we get information from the website instead of copying the data manually. Many Web-based data extraction methods are designed to solve specific problems and work on ad-hoc domains. Various tools and technologies have been developed to facilitate Web Scraping. Unfortunately, the appropriateness and ethics of using these Web Scraping tools are often overlooked. There are hundreds of web scraping software available today, most of them designed for Java, Python and Ruby. There is also open source software and commercial software. Web-based software such as YahooPipes, Google Web Scrapers and Firefox extensions for Outwit are the best tools for beginners in web cutting. Web extraction is basically used to cut this manual extraction and editing process and provide an easy and better way to collect data from a web page and convert it into the desired format and save it to a local or archive directory. In this paper, among others the kind of scrub, we focus on those techniques that extract the content of a Web page. In particular, we use scrubbing techniques for a variety of diseases with their own symptoms and precautions.

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