The Reliability of Telemedicine for Hospice Face-to-Face Recertification Visits: A Quality Improvement Project (FR408D)

Abstract

•Discuss the need for innovative technologies to support patient hospice recertification.•Examine the benefits and challenges to using teleconsultation in hospice recertification processes. The growing acceptance of hospice care, changes in reimbursement, and shortages of hospice clinicians requires hospices to find new ways to deliver high-quality and affordable care. To assess the reliability of using interactive teleconsultations for conducting face-to-face (F2F) hospice recertification visits. A quality improvement project was conducted to compare outcomes for F2F hospice recertification visits performed by an advance practice nurse or physician in-person and via teleconsultation simultaneously. Teleconsultation was achieved using HIPAA-compliant Zoom on cellular-enabled tablets. After each visit: 1) in-person clinicians completed a survey indicating their impression of the patient's hospice eligibility; 2) teleconsultation clinicians completed a survey indicating their impression of patient's hospice eligibility and a telemedicine usability questionnaire; and 3) patients or caregivers completed a telemedicine acceptability survey. Impressions of eligibility for recertification between in-person and teleconsultation providers were compared using McNemar's test for paired nominal data and exact binomial testing for outcomes with small cell values. Univariate descriptive analysis was used to summarize the usability and acceptability of the teleconsultation. An initial 21 of 200 planned visits (effect size 10% with 80% power) were completed in June-July 2019. In-person and teleconsultation clinicians agreed 100% on their impressions of the patient's hospice eligibility, indicating satisfactory agreement. Teleconsultation clinicians, patients and caregivers indicated they could hear, talk, and express themselves during the Zoom visit. Clinicians reported both benefits, tips, and challenges for using the teleconsultation system. Patients and caregivers reported they would use the teleconsultation for hospice care in the future. Preliminary results indicate telemedicine is a reliable, usable, and acceptable modality to conduct hospice F2F visits. Conducting F2F visits using innovative technologies, like mobile telemedicine, may help hospices to provide high-quality and affordable care.