S1235 Pilot Implementation of Video Telehealth for Gastrointestinal Sub-Specialty Care to Veterans During the COVID-19 Pandemic

Abstract

INTRODUCTION: In the setting of social distancing measures related to the COVID-19, we pilot tested implementation of VA Video Connect (VVC)—a VA-specific HIPAA-compliant video telehealth portal—for specialty gastrointestinal (GI) care at the Houston VA hospital. We assessed the impact of implementation by measuring patient and provider satisfaction measures with use of VVC. METHODS: Pilot implementation of GI specialty telehealth between March 13 and May 27, 2020 was based on Model for Improvement and Plan-Do-Study-Act (PDSA) framework. Weekly huddles were and rapid cycle PDSA cycles were performed. After each telehealth visit, providers rated visits for the following factors: overall satisfaction, technical difficulties, and missed crucial physical exam findings. Patients were surveyed on satisfaction, quality of encounter, and self-report of time-savings. All satisfaction scores were assessed using a 5-point Likert scale (1 = least satisfied; 5 = most satisfied). Demographic information was obtained via chart review. Summary statistics were performed, and multivariable logistic regression was performed to identify factors associated with technical difficulties with VVC. RESULTS: 155 VVC encounters by 6 providers were attempted. Hepatology accounted for 62% of visits, followed by IBD (31%), and GI motility (6.5%). Technical difficulties occurred in 71 (45.8%) of all encounters, with 118 (76.1%) completed using VVC alone (19.4% switched to telephone only; 4.5% to other video interface). Average provider satisfaction was 4.1 ± st.dev 1.2, and no providers reported management would have changed if in-person physical was available. 62 (40%) patients responded to the telephone survey (91% male; mean age 58 years). Average satisfaction with care was 5 ± 0.1, with quality of interface was 3.9 ± 1.4, and ease of technical set up [1.5 ± 1.1 (1 = very easy)]. Respondents lived a median of 22 miles (219mi for liver transplant), reported a median time saving of 2 hours. On multivariate analyses only age (Odds Ratio 1.23 [95% CI, 1.01–1.51; increment of 1 year]) was associated with technical difficulties. CONCLUSION: Our pilot implementation demonstrated VVC is feasible and acceptable to patients and providers, with high patient and provider satisfaction with VVC and substantial time savings for the patients. However, technical issues were common, and increased with patient age. Therefore, further resources directed towards studying and improving telehealth delivery are needed.