Patient Satisfaction and Trust in Telemedicine during the COVID-19 Pandemic (Preprint)

BACKGROUND Background: Los Angeles County is a hub for COVID-19 cases in the United States. Academic health centers rapidly deployed and leveraged telemedicine to permit uninterrupted care of patients. Telemedicine enjoys high patient satisfaction yet little is known about the level of satisfaction during a crisis and to what extent patient or visit-related factors and trust play when in-person visits are eliminated. OBJECTIVE Objective: To examine correlates of patients’ satisfaction with a telemedicine visit. METHODS Methods: In this retrospective observational study conducted in our single-institution, urban, academic medical center in Los Angeles, we surveyed internal medicine patients who had completed a telemedicine visit between March 10th and April 17th, 2020 (n=1624). Measures included degree of interpersonal trust in patient-physician relationships using the ”Trust in Physician Scale”, visit-related concerns, and post-visit recovery. Statistical analysis used descriptive statistics, Spearman rank-order correlation, and linear and ordinal logistic regression. RESULTS Results: Of 1,624 telemedicine visits conducted during this period, 368 (22.7%) patients participated in the survey. Across the study, respondents were very satisfied (47.4%) or satisfied (35.3%) with their telemedicine visit. Higher physician trust was associated with higher patient satisfaction (Spearman correlation r=0.51, P<.01). Visit-related factors with significant correlation with trust in physician score were report of telemedicine technical issues (r=-0.16), concerns about privacy (r=-0.19), concerns about cost (r=-0.23), satisfaction with telemedicine convenience (r=0.41), and amount of time spent (r=0.47) (all P<0.01). Visit-related factors associated with patients’ satisfaction included fewer technical issues (P<0.01), less concern about privacy (P<0.01) or cost (P=0.02), and successful face to face video (P<0.01). The only patient variable with a significant positive association was income and level of trust in physician (r=0.18, P<.01). Younger age was associated with higher telemedicine satisfaction (P<0.01). Despite high satisfaction and degree of trust, most respondents required in-person evaluation after the telemedicine visit, and only 12 respondents (3.9%) recovered at home without additional telemedicine visits or in-person evaluation at urgent care or emergency room. CONCLUSIONS Conclusions: Patients’ satisfaction with telemedicine during the COVID-19 pandemic is high. Their satisfaction is shaped by the degree of trust in physician and visit-related factors more so than patient factors. This has implications for outpatient practices and the widespread adoption of telemedicine and further research into visit-related factors and the patient-provider connection over telemedicine is needed. CLINICALTRIAL IRB Approval 7/6/2020 Proposal #HS-20-00479

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Patient Satisfaction and Trust in Telemedicine during the COVID-19 Pandemic (Preprint)

10.2196/preprints.28589 ◽

2021 ◽

Author(s):

Sharon Orrange ◽

Arpna Patel ◽

Wendy Jean Mack ◽

Julia Cassetta

Keyword(s):

Patient Satisfaction ◽

Los Angeles ◽

Rank Order ◽

Medical Center ◽

Academic Medical Center ◽

The United States ◽

Related Factors ◽

Significant Positive Association ◽

Patients Satisfaction ◽

Technical Issues

BACKGROUND Los Angeles County is a hub for COVID-19 cases in the United States. Academic health centers rapidly deployed and leveraged telemedicine to permit uninterrupted care of patients. Telemedicine enjoys high patient satisfaction, yet little is known about the level of satisfaction during a crisis and to what extent patient or visit-related factors and trust play when in-person visits are eliminated. OBJECTIVE To examine correlates of patients’ satisfaction with a telemedicine visit. METHODS In this retrospective observational study conducted in our single-institution, urban, academic medical center in Los Angeles, internal medicine patients aged 18 years and above who completed a telemedicine visit between March 10th and April 17th, 2020 were invited for a survey (n=1624). Measures included patient-demographics, degree of interpersonal trust in patient-physician relationships using the” Trust in Physician Scale,” and visit-related concerns. Statistical analysis used descriptive statistics, Spearman rank-order correlation, and linear and ordinal logistic regression. RESULTS Of 1,624 telemedicine visits conducted during this period, 368 (22.7%) patients participated in the survey. Across the study, respondents were very satisfied (47.4%) or satisfied (35.3%) with their telemedicine visit. Higher physician trust was associated with higher patient satisfaction (Spearman correlation r=0.51, P<.001). Visit-related factors with significant correlation with trust in physician score were technical issues with the telemedicine visit (r=-0.16), concerns about privacy (r=-0.19), concerns about cost (r=-0.23), satisfaction with telemedicine convenience (r=0.41), and amount of time spent (r=0.47) (all P<0.01). Visit-related factors associated with patients’ satisfaction included fewer technical issues (P<.001), less concern about privacy (P<.001) or cost (P=0.02), and successful face to face video (P<.001). The only patient variable with a significant positive association was income and level of trust in physician (r=0.18, P<.001). Younger age was associated with higher satisfaction with the telemedicine visit (P=.005). CONCLUSIONS There have been calls for redesigning primary care after the COVID-19 pandemic and for the widespread adoption of telemedicine. Patients’ satisfaction with telemedicine during the COVID-19 pandemic is high. Their satisfaction is shaped by the degree of trust in physician and visit-related factors more so than patient factors. This has widespread implications for outpatient practices and further research into visit-related factors and the patient-provider connection over telemedicine is needed. CLINICALTRIAL IRB Approval University of Southern California July 2020 HS-20-00479

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Patient Satisfaction and Trust in Telemedicine During the COVID-19 Pandemic: Retrospective Observational Study

JMIR Human Factors ◽

10.2196/28589 ◽

2021 ◽

Vol 8 (2) ◽

pp. e28589

Author(s):

Sharon Orrange ◽

Arpna Patel ◽

Wendy Jean Mack ◽

Julia Cassetta

Keyword(s):

Patient Satisfaction ◽

Los Angeles ◽

Observational Study ◽

Rank Order ◽

Academic Medical Center ◽

The United States ◽

Retrospective Observational Study ◽

Related Factors ◽

Patients Satisfaction ◽

Technical Issues

Background Los Angeles County is a hub for COVID-19 cases in the United States. Academic health centers rapidly deployed and leveraged telemedicine to permit uninterrupted care of patients. Telemedicine enjoys high patient satisfaction, yet little is known about the level of satisfaction during a crisis and to what extent patient- or visit-related factors and trust play when in-person visits are eliminated. Objective The aim of this study is to examine correlates of patients’ satisfaction with a telemedicine visit. Methods In this retrospective observational study conducted in our single-institution, urban, academic medical center in Los Angeles, internal medicine patients aged ≥18 years who completed a telemedicine visit between March 10th and April 17th, 2020, were invited for a survey (n=1624). Measures included patient demographics, degree of interpersonal trust in patient-physician relationships (using the Trust in Physician Scale), and visit-related concerns. Statistical analysis used descriptive statistics, Spearman rank-order correlation, and linear and ordinal logistic regression. Results Of 1624 telemedicine visits conducted during this period, 368 (22.7%) patients participated in the survey. Across the study, respondents were very satisfied (173/365, 47.4%) or satisfied (n=129, 35.3%) with their telemedicine visit. Higher physician trust was associated with higher patient satisfaction (Spearman correlation r=0.51, P<.001). Visit-related factors with statistically significant correlation with Trust in Physician score were technical issues with the telemedicine visit (r=–0.16), concerns about privacy (r=–0.19), concerns about cost (r=–0.23), satisfaction with telemedicine convenience (r=0.41), and amount of time spent (r=0.47; all P<.01). Visit-related factors associated with patients’ satisfaction included fewer technical issues (P<.001), less concern about privacy (P<.001) or cost (P=.02), and successful face-to-face video (P<.001). The only patient variable with a significant positive association was income and level of trust in physician (r=0.18, P<.001). Younger age was associated with higher satisfaction with the telemedicine visit (P=.005). Conclusions There have been calls for redesigning primary care after the COVID-19 pandemic and for the widespread adoption of telemedicine. Patients’ satisfaction with telemedicine during the COVID-19 pandemic is high. Their satisfaction is shaped by the degree of trust in physician and visit-related factors more so than patient factors. This has widespread implications for outpatient practices and further research into visit-related factors and the patient-provider connection over telemedicine is needed.

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A Chart Review of Substance Use Screening and Related Documentation among Adolescents in Outpatient Pediatric Clinics: Implications for Practice

10.21203/rs.2.19943/v2 ◽

2020 ◽

Author(s):

Lisa M. Kuhns ◽

Brookley Rogers ◽

Katie Greeley ◽

Abigail L. Muldoon ◽

Niranjan Karnik ◽

...

Keyword(s):

Primary Care ◽

Substance Use ◽

Logistic Regression ◽

Medical Center ◽

Academic Medical Center ◽

The United States ◽

Screening Tools ◽

Multiple Logistic Regression ◽

Related Factors ◽

Standardized Screening

Abstract Background: Despite recent reductions, youth substance use continues to be a concern in the United States. Structured primary care substance use screening among adolescents is recommended, but not widely implemented. The purpose of this study was to describe the distribution and characteristics of adolescent substance use screening in outpatient clinics in a large academic medical center and assess related factors (i.e., patient age, race/ethnicity, gender, and insurance type) to inform and improve the quality of substance use screening in practice. Methods: We abstracted a random sample of 127 records of patients aged 12-17 and coded clinical notes (e.g., converted open-ended notes to discrete values) to describe screening cases and related characteristics (e.g., which substances screened, how screened). We then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and used multiple logistic regression to identify related factors. Results: Among 127 records, rates of screening by providers were 72% (each) for common substances (alcohol, marijuana, tobacco). The primary method of screening was use of clinical mnemonic cues rather than standardized screening tools. A total of 6% of patients reported substance use during screening. Older age and racial/ethnic minority status were associated with provider screening in multiple logistic regression models. Conclusions: Despite recommendations, low rates of structured screening in primary care persist. Failure to use a standardized screening tool may contribute to low screening rates and biased screening. These findings may be used to inform implementation of standardized and structured screening in the clinical environment.

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A Chart Review of Substance Use Screening and Related Documentation among Adolescents in Outpatient Pediatric Clinics: Implications for Practice

10.21203/rs.2.19943/v1 ◽

2020 ◽

Author(s):

Lisa M. Kuhns ◽

Brookley Rogers ◽

Katie Greeley ◽

Abigail L. Muldoon ◽

Niranjan Karnik ◽

...

Keyword(s):

Primary Care ◽

Substance Use ◽

Logistic Regression ◽

Medical Center ◽

Academic Medical Center ◽

The United States ◽

Screening Tools ◽

Related Factors ◽

Multivariable Logistic Regression ◽

Standardized Screening

Abstract Background: Despite recent reductions, youth substance use continues to be a concern in the United States. Structured primary care screening is recommended, but not widely implemented. The purpose of this study was to describe substance use screening in a large academic medical center, assess related factors, and evaluate screening documentation to inform practice. Methods: We abstracted a random sample of 127 records of patients aged 12-17 and coded clinical notes to identify screening cases and related characteristics. We then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and used multivariable logistic regression to identify related factors. Results: Rates of screening by providers were 72% for common substances (alcohol, marijuana, tobacco). The primary method of screening was use of clinical pneumonic cues rather than standardized screening tools. A total of 6% of patients reported substance use during screening. Older age and racial/ethnic minority status were associated with provider screening in multivariable logistic regression models. Conclusions: Despite recommendations, low rates of screening in primary care persist. Failure to use a standardized screening tool may contribute to low screening rates and biased screening. These findings may be used to inform implementation of standardized and structured screening in the clinical environment.

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Perinatal Mood and Anxiety Disorder Management in Multicenter Community Practices: Clinicians’ Training, Current Practices and Perceived Strategies to Improve Future Implementation

Journal of Primary Care & Community Health ◽

10.1177/2150132721996888 ◽

2021 ◽

Vol 12 ◽

pp. 215013272199688

Author(s):

Ajeng J. Puspitasari ◽

Dagoberto Heredia ◽

Elise Weber ◽

Hannah K Betcher ◽

Brandon J. Coombes ◽

...

Keyword(s):

Anxiety Disorder ◽

Health Services ◽

Behavioral Health ◽

Psychiatric Symptoms ◽

Medical Center ◽

Academic Medical Center ◽

Management Training ◽

The United States ◽

Behavioral Health Services ◽

Perinatal Women

Background: This study aimed to explore clinicians’ perspectives on the current practice of perinatal mood and anxiety disorder (PMAD) management and strategies to improve future implementation. Methods: This study had a cross-sectional, descriptive design. A 35-item electronic survey was sent to clinicians (N = 118) who treated perinatal women and practiced at several community clinics at an academic medical center in the United States. Results: Among clinicians who provided care for perinatal women, 34.7% reported never receiving PMAD management training and 66.3% had less than 10 years of experience. Out of 10 patients who reported psychiatric symptoms, 47.8% of clinicians on average reported providing PMAD management to 1 to 3 patients and 40.7% noted that they conducted screening only when patient expresses PMAD symptoms. Suggested future improvements were providing training, developing a referral list, and establishing integrated behavioral health services. Conclusions: Results from this study indicated that while PMAD screening and management was implemented, improvements are warranted to meet established guidelines. Additionally, clinicians endorsed providing PMAD management to a small percentage of perinatal patients. Suggested strategies to increase adoption and implementation of PMAD management should be explored to improve access to behavioral health services for perinatal women.

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Communications and Screening for 2019 Novel Coronavirus at a Tertiary-Care Medical Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.578 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s84-s84

Author(s):

Lorinda Sheeler ◽

Mary Kukla ◽

Oluchi Abosi ◽

Holly Meacham ◽

Stephanie Holley ◽

...

Keyword(s):

Screening Tool ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

The United States ◽

World Health ◽

Communication Campaign ◽

Electronic Screening ◽

Novel Coronavirus ◽

The Impact

Background: In December of 2019, the World Health Organization reported a novel coronavirus (severe acute respiratory coronavirus virus 2 [SARS-CoV-2)]) causing severe respiratory illness originating in Wuhan, China. Since then, an increasing number of cases and the confirmation of human-to-human transmission has led to the need to develop a communication campaign at our institution. We describe the impact of the communication campaign on the number of calls received and describe patterns of calls during the early stages of our response to this emerging infection. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center with >200 outpatient clinics. In response to the coronavirus disease 2019 (COVID-19) outbreak, we launched a communications campaign on January 17, 2020. Initial communications included email updates to staff and a dedicated COVID-19 webpage with up-to-date information. Subsequently, we developed an electronic screening tool to guide a risk assessment during patient check in. The screening tool identifies travel to China in the past 14 days and the presence of symptoms defined as fever >37.7°C plus cough or difficulty breathing. The screening tool was activated on January 24, 2020. In addition, university staff contacted each student whose primary residence record included Hubei Province, China. Students were provided with medical contact information, signs and symptoms to monitor for, and a thermometer. Results: During the first 5 days of the campaign, 3 calls were related to COVID-19. The number of calls increased to 18 in the 5 days following the implementation of the electronic screening tool. Of the 21 calls received to date, 8 calls (38%) were generated due to the electronic travel screen, 4 calls (19%) were due to a positive coronavirus result in a multiplex respiratory panel, 4 calls (19%) were related to provider assessment only (without an electronic screening trigger), and 2 calls (10%) sought additional information following the viewing of the web-based communication campaign. Moreover, 3 calls (14%) were for people without travel history but with respiratory symptoms and contact with a person with recent travel to China. Among those reporting symptoms after travel to China, mean time since arrival to the United States was 2.7 days (range, 0–11 days). Conclusion: The COVID-19 outbreak is evolving, and providing up to date information is challenging. Implementing an electronic screening tool helped providers assess patients and direct questions to infection prevention professionals. Analyzing the types of calls received helped tailor messaging to frontline staff.Funding: NoneDisclosures: None

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Evaluation of Patient Experience from Telemedicine Use for an Anesthesiology Pain Division: Time, Cost, and Patient Satisfaction Analysis (Preprint)

10.2196/preprints.33926 ◽

2021 ◽

Author(s):

Laleh Jalilian ◽

Irene Wu ◽

Jakun Ing ◽

Xuezhi Dong ◽

George Pan ◽

...

Keyword(s):

Patient Satisfaction ◽

Pain Management ◽

Travel Time ◽

Medical Center ◽

Academic Medical Center ◽

Cost Savings ◽

Travel Distance ◽

Patient Cost ◽

Academic Medical ◽

Pain Patients

BACKGROUND An increasing number of patients require outpatient and interventional pain management. To help meet the rising demand for anesthesia pain subspecialty care in rural and metropolitan areas, healthcare providers have utilized telemedicine for pain management of both interventional and chronic pain patients. OBJECTIVE This study describes telemedicine implementation for pain management at an academic pain division in a large metropolitan area. The study estimates patient cost savings from telemedicine, before and after the California COVID-19 "Safer at Home" directive, and patient satisfaction with telemedicine for pain management care. METHODS This was a retrospective, observational case series study of telemedicine use in a pain division at an urban academic medical center. From August 2019 to June 2020, we evaluated 1,398 patients and conducted 2,948 video visits for remote pain management care. We utilize publicly available IRS Statistics of Income data to estimate hourly earnings by zip code in order to estimate patient cost savings. We estimate median travel time, travel distance, direct cost of travel, and time-based opportunity savings and report patient satisfaction scores. RESULTS Telemedicine patients avoided an estimated median roundtrip driving distance of 26 miles and a median travel time of 69 minutes during afternoon traffic conditions. Within sample, the median hourly earnings was $28/hr. Patients saved a median of $22 on gas and parking and a total of $52 per telemedicine visit based on estimated hourly earnings and travel time. Patients evaluated serially with telemedicine for medication management saved a median of $156 over three visits. 91% of patients surveyed (n = 313) were satisfied with their telemedicine experience. CONCLUSIONS Telemedicine use for pain management reduced travel distance, travel time, and travel and time-based opportunity costs for pain patients. We achieved the successful implementation of telemedicine across a pain division in an urban academic medical center with high patient satisfaction and patient cost savings.

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An innovative resident-driven mortality case review curriculum to teach and drive system-based practice improvements in the United States

Journal of Educational Evaluation for Health Professions ◽

10.3352/jeehp.2018.15.31 ◽

2018 ◽

Vol 15 ◽

pp. 31

Author(s):

Nila S. Radhakrishnan ◽

Margaret C. Lo ◽

Rohit Bishnoi ◽

Subhankar Samal ◽

Robert Leverence ◽

...

Keyword(s):

Quality Improvement ◽

Systems Of Care ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

The United States ◽

Case Review ◽

Failure To Rescue ◽

Internal Medicine Residents ◽

Mortality Case

Purpose: Traditionally, the morbidity and mortality conference (M&MC) is a forum where possible medical errors are discussed. Although M&MCs can facilitate identification of opportunities for systemwide improvements, few studies have described their use for this purpose, particularly in residency training programs. This paper describes the use of M&MC case review as a quality improvement activity that teaches system-based practice and can engage residents in improving systems of care. Methods: Internal medicine residents at a tertiary care academic medical center reviewed 347 consecutive mortalities from March 2014 to September 2017. The residents used case review worksheets to categorize and track causes of mortality, and then debriefed with a faculty member. Selected cases were then presented at a larger interdepartmental meeting and action items were implemented. Descriptive statistics and thematic analysis were used to analyze the results. Results: The residents identified a possible diagnostic mismatch at some point from admission to death in 54.5% of cases (n= 189) and a possible need for improved management in 48.0% of cases. Three possible management failure themes were identified, including failure to plan, failure to communicate, and failure to rescue, which accounted for 21.9%, 10.7 %, and 10.1% of cases, respectively. Following these reviews, quality improvement initiatives proposed by residents led to system-based changes. Conclusion: A resident-driven mortality review curriculum can lead to improvements in systems of care. This novel type of curriculum can be used to teach system-based practice. The recruitment of teaching faculty with expertise in quality improvement and mortality case analyses is essential for such a project.

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Depression Screening and Measurement-Based Care in Primary Care

Journal of Primary Care & Community Health ◽

10.1177/2150132720931261 ◽

2020 ◽

Vol 11 ◽

pp. 215013272093126

Author(s):

Kimberly A. Siniscalchi ◽

Marion E. Broome ◽

Jason Fish ◽

Joseph Ventimiglia ◽

Julie Thompson ◽

...

Keyword(s):

Primary Care ◽

Task Force ◽

Medical Center ◽

Academic Medical Center ◽

Unmet Need ◽

The United States ◽

Depression Screening ◽

Improvement Project ◽

Measurement Based Care

The health issue addressed is the unmet need to universally screen and treat depression, which is one of the most common mental health disorders among adults in the United States. The US Preventive Services Task Force recommends screening adults for depression in primary care and using evidence-based protocols. This quality improvement project implemented VitalSign6, a measurement-based care program, to improve depression screening and treatment of adults in primary care at an academic medical center. A pre-post design was used to determine effectiveness of changes in screening, outcomes, and satisfaction. Of 1200 unique adult patients, 95.4% received initial screening. Providers diagnosed and administered measurement-based care to 236 patients. After 14 weeks, 27.5% returned for at least 1 follow-up. Results showed a statistically significant decrease in self-reported depression scores from baseline to follow-up. VitalSign6 was effective in improving identification and management of depression in primary care.

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Clinical Ordering Practices of the SARS-CoV-2 Antibody Test at a Large Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa406 ◽

2020 ◽

Vol 7 (10) ◽

Author(s):

Joesph R Wiencek ◽

Carter L Head ◽

Costi D Sifri ◽

Andrew S Parsons

Keyword(s):

United States ◽

Medical Center ◽

Academic Medical Center ◽

Antibody Test ◽

The United States ◽

Molecular Testing ◽

Antibody Testing ◽

Academic Medical ◽

Public Health Epidemiology ◽

Testing Costs

Abstract Background The novel severe acute respiratory coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) originated in December 2019 and has now infected almost 5 million people in the United States. In the spring of 2020, private laboratories and some hospitals began antibody testing despite limited evidence-based guidance. Methods We conducted a retrospective chart review of patients who received SARS-CoV-2 antibody testing from May 14, 2020, to June 15, 2020, at a large academic medical center, 1 of the first in the United States to provide antibody testing capability to individual clinicians in order to identify clinician-described indications for antibody testing compared with current expert-based guidance from the Infectious Diseases Society of America (IDSA) and the Centers for Disease Control and Prevention (CDC). Results Of 444 individual antibody test results, the 2 most commonly described testing indications, apart from public health epidemiology studies (n = 223), were for patients with a now resolved COVID-19-compatible illness (n = 105) with no previous molecular testing and for asymptomatic patients believed to have had a past exposure to a person with COVID-19-compatible illness (n = 60). The rate of positive SARS-CoV-2 antibody testing among those indications consistent with current IDSA and CDC guidance was 17% compared with 5% (P < .0001) among those indications inconsistent with such guidance. Testing inconsistent with current expert-based guidance accounted for almost half of testing costs. Conclusions Our findings demonstrate a dissociation between clinician-described indications for testing and expert-based guidance and a significantly different rate of positive testing between these 2 groups. Clinical curiosity and patient preference appear to have played a significant role in testing decisions and substantially contributed to testing costs.

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