Evaluation of an Intrahospital Telemedicine Program for Patients Admitted With COVID-19: Mixed Methods Study

BackgroundThe increasing incidence of COVID-19 infection has challenged health care systems to increase capacity while conserving personal protective equipment (PPE) supplies and minimizing nosocomial spread. Telemedicine shows promise to address these challenges but lacks co...

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Main Authors: Legler, Sean, Diehl, Matthew, Hilliard, Brian, Olson, Andrew, Markowitz, Rebecca, Tignanelli, Christopher, Melton, Genevieve B, Broccard, Alain, Kirsch, Jonathan, Usher, Michael
Format: Article
Language:English
Published: JMIR Publications 2021-04-01
Series:Journal of Medical Internet Research
Online Access:https://www.jmir.org/2021/4/e25987
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spelling doaj-b46d629f242c4e48ae4259959c4187942021-04-29T15:01:08ZengJMIR PublicationsJournal of Medical Internet Research1438-88712021-04-01234e2598710.2196/25987Evaluation of an Intrahospital Telemedicine Program for Patients Admitted With COVID-19: Mixed Methods StudyLegler, SeanDiehl, MatthewHilliard, BrianOlson, AndrewMarkowitz, RebeccaTignanelli, ChristopherMelton, Genevieve BBroccard, AlainKirsch, JonathanUsher, Michael BackgroundThe increasing incidence of COVID-19 infection has challenged health care systems to increase capacity while conserving personal protective equipment (PPE) supplies and minimizing nosocomial spread. Telemedicine shows promise to address these challenges but lacks comprehensive evaluation in the inpatient environment. ObjectiveThe aim of this study is to evaluate an intrahospital telemedicine program (virtual care), along with its impact on exposure risk and communication. MethodsWe conducted a natural experiment of virtual care on patients admitted for COVID-19. The primary exposure variable was documented use of virtual care. Patient characteristics, PPE use rates, and their association with virtual care use were assessed. In parallel, we conducted surveys with patients and clinicians to capture satisfaction with virtual care along the domains of communication, medical treatment, and exposure risk. ResultsOf 137 total patients in our primary analysis, 43 patients used virtual care. In total, there were 82 inpatient days of use and 401 inpatient days without use. Hospital utilization and illness severity were similar in patients who opted in versus opted out. Virtual care was associated with a significant reduction in PPE use and physical exam rate. Surveys of 41 patients and clinicians showed high rates of recommendation for further use, and subjective improvements in communication. However, providers and patients expressed limitations in usability, medical assessment, and empathetic communication. ConclusionsIn this pilot natural experiment, only a subset of patients used inpatient virtual care. When used, virtual care was associated with reductions in PPE use, reductions in exposure risk, and patient and provider satisfaction.https://www.jmir.org/2021/4/e25987
collection DOAJ
language English
format Article
sources DOAJ
author Legler, Sean
Diehl, Matthew
Hilliard, Brian
Olson, Andrew
Markowitz, Rebecca
Tignanelli, Christopher
Melton, Genevieve B
Broccard, Alain
Kirsch, Jonathan
Usher, Michael
spellingShingle Legler, Sean
Diehl, Matthew
Hilliard, Brian
Olson, Andrew
Markowitz, Rebecca
Tignanelli, Christopher
Melton, Genevieve B
Broccard, Alain
Kirsch, Jonathan
Usher, Michael
Evaluation of an Intrahospital Telemedicine Program for Patients Admitted With COVID-19: Mixed Methods Study
Journal of Medical Internet Research
author_facet Legler, Sean
Diehl, Matthew
Hilliard, Brian
Olson, Andrew
Markowitz, Rebecca
Tignanelli, Christopher
Melton, Genevieve B
Broccard, Alain
Kirsch, Jonathan
Usher, Michael
author_sort Legler, Sean
title Evaluation of an Intrahospital Telemedicine Program for Patients Admitted With COVID-19: Mixed Methods Study
title_short Evaluation of an Intrahospital Telemedicine Program for Patients Admitted With COVID-19: Mixed Methods Study
title_full Evaluation of an Intrahospital Telemedicine Program for Patients Admitted With COVID-19: Mixed Methods Study
title_fullStr Evaluation of an Intrahospital Telemedicine Program for Patients Admitted With COVID-19: Mixed Methods Study
title_full_unstemmed Evaluation of an Intrahospital Telemedicine Program for Patients Admitted With COVID-19: Mixed Methods Study
title_sort evaluation of an intrahospital telemedicine program for patients admitted with covid-19: mixed methods study
publisher JMIR Publications
series Journal of Medical Internet Research
issn 1438-8871
publishDate 2021-04-01
description BackgroundThe increasing incidence of COVID-19 infection has challenged health care systems to increase capacity while conserving personal protective equipment (PPE) supplies and minimizing nosocomial spread. Telemedicine shows promise to address these challenges but lacks comprehensive evaluation in the inpatient environment. ObjectiveThe aim of this study is to evaluate an intrahospital telemedicine program (virtual care), along with its impact on exposure risk and communication. MethodsWe conducted a natural experiment of virtual care on patients admitted for COVID-19. The primary exposure variable was documented use of virtual care. Patient characteristics, PPE use rates, and their association with virtual care use were assessed. In parallel, we conducted surveys with patients and clinicians to capture satisfaction with virtual care along the domains of communication, medical treatment, and exposure risk. ResultsOf 137 total patients in our primary analysis, 43 patients used virtual care. In total, there were 82 inpatient days of use and 401 inpatient days without use. Hospital utilization and illness severity were similar in patients who opted in versus opted out. Virtual care was associated with a significant reduction in PPE use and physical exam rate. Surveys of 41 patients and clinicians showed high rates of recommendation for further use, and subjective improvements in communication. However, providers and patients expressed limitations in usability, medical assessment, and empathetic communication. ConclusionsIn this pilot natural experiment, only a subset of patients used inpatient virtual care. When used, virtual care was associated with reductions in PPE use, reductions in exposure risk, and patient and provider satisfaction.
url https://www.jmir.org/2021/4/e25987
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