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 Evaluating the Telehealth Experience of Patients With COVID-19 Symptoms: Recommendations on Best Practices

2020 ◽  
Vol 7 (5) ◽  
pp. 665-672
Author(s):  
Saif Khairat ◽  
Malvika Pillai ◽  
Barbara Edson ◽  
Robert Gianforcaro
Keyword(s):  
Best Practices ◽  
Wait Time ◽  
Wait Times ◽  
Major Drawback ◽  
Cross Sectional ◽  
Care Experience ◽  
Adherence To Medication ◽  
Patient Reported ◽  
Visit Duration ◽  
Virtual Visits

Positive patient experiences are associated with illness recovery and adherence to medication. To evaluate the virtual care experience for patients with COVID-19 symptoms as their chief complaints. We conducted a cross-sectional study of the first cohort of patients with COVID-19 symptoms in a virtual clinic. The main end points of this study were visit volume, wait times, visit duration, patient diagnosis, prescriptions received, and satisfaction. Of the 1139 total virtual visits, 212 (24.6%) patients had COVID-19 symptoms. The average wait time (SD) for all visits was 75.5 (121.6) minutes. The average visit duration for visits was 10.5 (4.9) minutes. The highest volume of virtual visits was on Saturdays (39), and the lowest volume was on Friday (19). Patients experienced shorter wait times (SD) on the weekdays 67.1 (106.8) minutes compared to 90.3 (142.6) minutes on the weekends. The most common diagnoses for patients with COVID-19 symptoms were upper respiratory infection. Patient wait times for a telehealth visit varied depending on the time and day of appointment. Long wait times were a major drawback in the patient experience. Based on patient-reported experience, we proposed a list of general, provider, and patient telehealth best practices.

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.

The next generation of quality improvement at MSK: Turning chemotherapy process delays into chemo express.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18230-e18230
Author(s):  
Jennifer Tota ◽  
Kathleen Levine ◽  
Jeanine Gordon ◽  
Abigail Baldwin ◽  
Jodi Wald ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Patient Experience ◽  
Wait Time ◽  
Wait Times ◽  
Pilot Program ◽  
Treatment Results ◽  
Average Wait Time ◽  
Major Bottleneck ◽  
Work Done

e18230 Background: Chemotherapy wait times can dramatically affect patient experience. MSK’s largest outpatient facility has 76 infusion spaces and 250-300 daily visits. A retrospective review of the facility’s infusion area wait times suggested that the lab (where all patients go to get their vitals and blood drawn) was a major bottleneck leading to process delays in infusion. Methods: We conducted a pilot program using a multi-pronged approach. Our goal was to decrease wait time from 40 minutes to an average of 15 minutes. Our initiative was defined as follows: (1) to redefine lab parameters that are relevant for toxicity and to only consider drawing those necessary labs; additionally, we created guidelines for timing of the labs prior to infusion treatment, (2) to introduce a program known as “ChemoExpress” which offers patients the opportunity to get blood work done prior to the day of their infusion appointment. After the labs result, the outpatient RN calls the patient, assesses symptoms and “clears them” for treatment cueing the pharmacy to prepare and “premix” the drug on the day of treatment. Results: 150 patients have enrolled in ChemoExpress. Patient satisfaction was high based on patient satisfaction surveys (n = 20). Average wait time was 9 minutes (76% less) in ChemoExpress participants as compared to an average wait of 39 minutes for those who did not participate in ChemoExpress. Conclusions: Implementing a process that enables patients to have their bloodwork drawn prior to the day of treatment and drugs prepared in advance of their treatment appointment results in greater efficiency in the overall workflow. It also offers the patient a lower wait time and a more efficient and satisfying experience.

Socioeconomic Disparities in the demand for and use of virtual visits among senior adults during the COVID-19 pandemic: A cross-sectional study (Preprint)

2021 ◽  
Author(s):  
Ellie Yu
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Services ◽  
Socioeconomic Disparities ◽  
Cross Sectional ◽  
Secure Messaging ◽  
Negatively Associated ◽  
Care Services ◽  
Virtual Care ◽  
Virtual Visits

BACKGROUND The COVID-19 pandemic has limited the provision of in-person care and accelerated the need for virtual care. Older adults (65+) were one of the highest user groups of in-person health care services prior to the pandemic. Social-distancing guidelines and high rates of mortality from coronavirus infections among older adults made receiving in-person health care services challenging for older adults. The provision of virtual care technologies can help to ensure continuity of care and provide essential health care services during the pandemic to those in high-risk groups at contracting the COVID-19 coronavirus including older adults. It is also essential to understand and address potential socioeconomic, demographic, and health disparities in the demand for use of virtual care technologies among older adults. OBJECTIVE The objective of this study is to investigate socioeconomic disparities in the demand for and use of virtual visit during the COVID-19 pandemic among older adults in Canada. METHODS A cross-sectional web survey was conducted with 12,052 Canadians over the age of 16, selected from Leger’s LEO panel between July 14th to August 6th, 2021. Associations between socioeconomic factors and the demand for and use of virtual visits were tested using the χ2 tests and logistic regression models. Weighting was applied using the 2016 census reference variables to render a representative sample of the Canadian population. RESULTS Approximately 20% (n=2,303) of the survey sample were older adults above the age of 65. The proportion of older adults who expressed demand for telephone visit, video visits, and secure messaging were 69.6%, 49.2%, and 47.2%, respectively. The proportion of older adults in our sample who have used telephone visit in the past 12 months was 47.3%, 9.2%, and 8.4%, respectively. eHealth literacy was positively associated with use of telephone visits (OR 1.03, p=0.01), use of video visits (OR 1.04, p=0.00), and the use of secure messaging (OR 1.03, p=0.00). Income was negatively associated with the use of video visits (OR 0.65, p=0.03). Having no private insurance coverage was negatively associated with use of secure messaging (OR 0.73, p=0.04) but living in a rural community (OR 1.72, p=0.01) and being born outside of Canada (OR 1.50, p=0.03) were positively associated with the use of secure messaging. Education (OR 0.78, p=0.02) and being non-White (OR=0.54, p=0.02) were negatively associated with the use of telephone visits. CONCLUSIONS This study found that demand for and use of telephone visit services were more prevalent among older adults during the pandemic. Although demand for secure messaging and video visit is high, usage for these modalities remains low. The results highlight several socioeconomic factors that are associated with demand for virtual visits including language, community size, and health coverage.

Virtual vs traditional care settings for low-acuity urgent conditions: An economic analysis of cost and utilization using claims data

2019 ◽  
pp. 1357633X1986123
Author(s):  
Tim Lovell ◽  
Jordan Albritton ◽  
Joe Dalto ◽  
Cheryl Ledward ◽  
William Daines
Keyword(s):  
Primary Care ◽  
Emergency Care ◽  
Antibiotic Use ◽  
Cost Of Care ◽  
Urgent Care ◽  
Cross Sectional ◽  
Care Programme ◽  
Virtual Care ◽  
Virtual Visits

Background On-demand, direct-to-consumer video (or virtual) visits represent one of the fastest growing telemedicine services. Due to the absence of an in-person physical examination, some question the effectiveness, efficiency and value of virtual care visits. To address these questions, we conducted a retrospective, cross-sectional review of Intermountain Healthcare’s virtual care programme. Method This study used SelectHealth claims for virtual, urgent, primary and emergency care delivered between 1 April 2016–31 March 2017. We included all claims with primary diagnosis from the nine most common categories for virtual care. A secondary data source included survey data indicating how virtual visits redirect care. Results We matched 1531 virtual visit claims with claims from urgent (4377), primary (4388) and emergency care (2285). There were no differences in follow-up rates between virtual and urgent care and no differences in antibiotic use between virtual and urgent or primary care. Virtual care was significantly lower than all other care settings in utilization of laboratory and imaging services, index visit cost and total costs over 21 days. Conclusions This study affirmed lower cost for virtual care without an associated increase in overall follow-up rates or antibiotic use when compared with urgent or primary care. This suggests that virtual visits are can be used to lower the total cost of care for applicable conditions. The implications are that virtual visits help lower operational costs of providing care, particularly in integrated systems with capitated reimbursement. Under the right circumstances, the increased adoption of virtual care should lead to greater savings.

scholarly journals Changes in the top 25 reasons for primary care visits during the COVID-19 pandemic in a high-COVID region of Canada

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255992
Author(s):  
Ellen Stephenson ◽  
Debra A. Butt ◽  
Jessica Gronsbell ◽  
Catherine Ji ◽  
Braden O’Neill ◽  
...  
Keyword(s):  
Primary Care ◽  
Preventive Care ◽  
Research Network ◽  
Secondary Outcome ◽  
Primary Care Visit ◽  
Virtual Care ◽  
Number Of Patients ◽  
Before And After ◽  
Practice Based Research ◽  
Virtual Visits

Purpose We aimed to determine the degree to which reasons for primary care visits changed during the COVID-19 pandemic. Methods We used data from the University of Toronto Practice Based Research Network (UTOPIAN) to compare the most common reasons for primary care visits before and after the onset of the COVID-19 pandemic, focusing on the number of visits and the number of patients seen for each of the 25 most common diagnostic codes. The proportion of visits involving virtual care was assessed as a secondary outcome. Results UTOPIAN family physicians (N = 379) conducted 702,093 visits, involving 264,942 patients between March 14 and December 31, 2019 (pre-pandemic period), and 667,612 visits, involving 218,335 patients between March 14 and December 31, 2020 (pandemic period). Anxiety was the most common reason for visit, accounting for 9.2% of the total visit volume during the pandemic compared to 6.5% the year before. Diabetes and hypertension remained among the top 5 reasons for visit during the pandemic, but there were 23.7% and 26.2% fewer visits and 19.5% and 28.8% fewer individual patients accessing care for diabetes and hypertension, respectively. Preventive care visits were substantially reduced, with 89.0% fewer periodic health exams and 16.2% fewer well-baby visits. During the pandemic, virtual care became the dominant care format (77.5% virtual visits). Visits for anxiety and depression were the most common reasons for a virtual visit (90.6% virtual visits). Conclusion The decrease in primary care visit volumes during the COVID-19 pandemic varied based on the reason for the visit, with increases in visits for anxiety and decreases for preventive care and visits for chronic diseases. Implications of increased demands for mental health services and gaps in preventive care and chronic disease management may require focused efforts in primary care.

scholarly journals How Do Virtual Visits Compare? Parent Satisfaction With Pediatric Diabetes Telehealth During the COVID-19 Pandemic

2022 ◽  
Vol 2 ◽  
Author(s):  
Christine A. March ◽  
Radhika Muzumdar ◽  
Ingrid Libman
Keyword(s):  
Parent Satisfaction ◽  
Routine Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Stakeholder Perspectives ◽  
Virtual Care ◽  
Pediatric Diabetes ◽  
The Future ◽  
Care Models ◽  
Virtual Visits

BackgroundIn response to the COVID-19 pandemic, many countries relaxed restrictions on telemedicine, allowing for a robust transition to virtual visits for routine care. In response, centers rapidly instituted and scaled telemedicine for pediatric diabetes care. Despite numerous center reports on their experience, little is known about parent perspectives on the widespread increase of telemedicine for pediatric diabetes appointments.ObjectiveTo assess parent satisfaction with virtual care for pediatric diabetes during the COVID-19 pandemic.MethodsWe conducted an online, cross-sectional survey of parents of youth with diabetes who receive care at a large, academic diabetes center regarding their perspectives on newly introduced virtual appointments. Parents were surveyed at two time points during the pandemic using a validated scale which was adapted for diabetes. We explored demographic and clinical factors which may influence parental satisfaction.ResultsOverall, parents expressed high levels of satisfaction (&gt;90%) with functional aspects of the visit, though only approximately half (56%) felt the visit was as good as an in-person encounter. Nearly three-quarters (74%) would consider using telemedicine again in the future. Prior use of telemedicine significantly influenced parent satisfaction, suggesting that parent preferences may play a role in continued use of telemedicine in the future. There was no difference in responses across the two timepoints, suggesting high satisfaction early in the pandemic which persisted.ConclusionsIf permissive policies for telemedicine continue, diabetes centers could adopt hybrid in-person and virtual care models, while considering various stakeholder perspectives (providers and patients) and equity in access to virtual care.

scholarly journals Sociodemographic differences in patient experience with virtual care during COVID-19

2021 ◽  
Author(s):  
Payal Agarwal ◽  
Rick Wang ◽  
Christopher Meaney ◽  
Sakina Walji ◽  
Ali Damji ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Experience ◽  
Primary Care Clinic ◽  
Sociodemographic Factors ◽  
Care Seeking ◽  
Cross Sectional ◽  
Care Clinic ◽  
Virtual Care ◽  
Birth Month ◽  
Chi Squared

Purpose: We sought to understand patients care-seeking behaviours during the pandemic, their use and views of different virtual care modalities, and whether these differed by sociodemographic factors. Methods: We conducted a multi-site cross-sectional patient experience survey at thirteen academic primary care teaching practices between May and June of 2020. An anonymized link to an electronic survey was sent to a subset of patients with a valid email address on file; sampling was based on birth month. For each question, the proportion of respondents who selected each response was calculated, followed by a comparison by sociodemographic characteristics using chi-squared tests. Results: In total, 7482 participants responded to the survey. Most received care from their primary care clinic during the pandemic (67.7%, 5068/7482), the majority via phone (82.5%, 4195/5086). Among those who received care, 30.53% (1509/4943) stated that they delayed seeking care because of the pandemic. Most participants reported a high degree of comfort with phone (92.4%, 3824/4139), video (95.2%, 238/250) and email or messaging (91.3%, 794/870). However, those reporting difficulty making ends meet, poor or fair health, and arriving in Canada in the last 10 years reported lower levels of comfort with virtual care and fewer wanted their practice to continue offering virtual options after the pandemic. Conclusions: Our study suggest that newcomers, people living with a lower income, and those reporting poor or fair health have a stronger preference and comfort for in-person primary care. Further research should explore potential barriers to virtual care and how these could be addressed.

scholarly journals Evaluating the Experiences of New and Existing Teledermatology Patients post-Covid19 Implementation (Preprint)

2020 ◽  
Author(s):  
Judy Hamad ◽  
Amy Fox ◽  
Maria Suzanne Kammire ◽  
Alison Nancy Hollis ◽  
Saif Khairat
Keyword(s):  
Patient Satisfaction ◽  
Patient Experience ◽  
Medical Center ◽  
Cross Sectional Study ◽  
Rapid Expansion ◽  
Secondary Outcome ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Significant Difference ◽  
Willingness To Use

BACKGROUND With the rapid shift to remodel office-based dermatology into virtual clinics during the coronavirus disease-19 (Covid-19) pandemic teledermatology received an upsurge of utilization. OBJECTIVE To assess the patient experience with teledermatology among new versus existing clinic patients in the context of the rapid practice shift to teledermatology during the Covid-19 pandemic. METHODS We report a cross-sectional study of 184 teledermatology patients seen during Covid-19 at a major Southeastern medical center from May 13th to June 5th 2020. The primary outcome was patient satisfaction levels among new and existing patients. The secondary outcome was future willingness to use teledermatology. RESULTS Of 288 teledermatology patients seen during the study period, 184 (64%) completed the survey. Patients reported high overall satisfaction with teledermatology (Figure 1), with 159 (86%) participants reporting positive overall satisfaction and experience with teledermatology. New patients had significantly higher overall satisfaction with teledermatology than follow-up patients (mean Likert 4.70 for new, 4.43 for existing; p=0.03). Overall, satisfaction with teledermatology did not significantly differ by age, race/ethnicity, education level, residence, or insurance status (p>0.05). There was no significant difference in overall satisfaction by prior telehealth experience (p=0.53), video versus telephone visit type (p=0.17), or platform type (0.22). Prior telehealth experience was associated with a higher odds of willingness to use telehealth in the future (OR 2.39, 95% CI 1.31-4.35, p=0.004). CONCLUSIONS This cross-sectional survey-based study reports that the rapid expansion of teledermatology was met with high levels of patient satisfaction during the Covid-19 pandemic. Further studies are needed to identify ideal disease-specific scheduling algorithms to ensure the visit modality suits the dermatologic condition being addressed. As teledermatology experiences wider adoption with the Covid-19 pandemic, it is essential to examine patient experience and satisfaction with teledermatology.

Patient Tolerability of Bowel Preparation is Associated with Polyp Detection Rate During Colonoscopy

2014 ◽  
Vol 23 (2) ◽  
pp. 135-140 ◽  
Author(s):  
Edward W. Holt ◽  
Kidist K. Yimam ◽  
Hanley Ma ◽  
Richard E. Shaw ◽  
Richard A. Sundberg ◽  
...  
Keyword(s):  
Bowel Preparation ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Polyp Detection ◽  
Cross Sectional ◽  
Quality Outcomes ◽  
Negative Experience ◽  
Polyp Detection Rate ◽  
Patient Reported ◽  
Bowel Prep

Background & Aims: A number of factors have been identified that influence the yield of screeningcolonoscopy. The perceived tolerability of bowel preparation has not been studied as a predictor of quality outcomes in colonoscopy. We aimed to characterize the association between patient-perceived tolerability of bowel preparation and polyp detection during colonoscopy.Methods: We performed a cross-sectional cohort study of 413 consecutive adult patients presenting foroutpatient colonoscopy at two outpatient endoscopy centers at our institution. We developed a standardized questionnaire to assess the patient's experience with bowel preparation. Bowel preparation quality was measured using the validated Ottawa scale and colonoscopic findings were recorded for each patient. The primary outcome was polyp detection and the secondary outcome was the quality of bowel preparation.Results: Patient-reported clarity of effluent during bowel preparation correlated poorly with Ottawa score during colonoscopy, k=0.15. Female gender was an independent risk factor for a poorly tolerated bowel prep (OR 3.93, 95% CI 2.30 - 6.72, p<0.001). Report of a poorly tolerated bowel prep was independently associated with the primary outcome, polyp detection (OR 0.39, 95% CI 0.18 - 0.84, p=0.02) and also with the secondary outcome, lower quality bowel preparation (OR 2.39, 95% CI 1.17 - 4.9, p=0.02).Conclusions: A patient-perceived negative experience with bowel preparation independently predicted both a lower quality bowel preparation and a lower rate of polyp of detection. Assessment of the tolerability of bowel preparation before colonoscopy may be a clinically useful predictor of quality outcomes during colonoscopy.

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