Telehealth Assessment Research Articles

Provider and Caregiver Perspectives on Telehealth Assessments for Autism Spectrum Disorder in Young Children: A Multimethod DBPNet Study Exploring Equity.

Telehealth uptake increased dramatically during the COVID-19 pandemic, including for autism spectrum disorder (ASD) assessment by developmental-behavioral pediatric (DBP) clinicians. However, little is known about the acceptability of telehealth or its impact on equity in DBP care. Engage providers and caregivers to glean their perspectives on the use of telehealth for ASD assessment in young children, exploring acceptability, benefits, concerns, and its potential role in ameliorating or exacerbating disparities in access to and quality of DBP care. This multimethod study used surveys and semistructured interviews to describe provider and family perspectives around the use of telehealth in DBP evaluation of children younger than 5 years with possible ASD between 3/2020 and 12/2021. Surveys were completed by 13 DBP clinicians and 22 caregivers. Semistructured interviews with 12 DBP clinicians and 14 caregivers were conducted, transcribed, coded, and analyzed thematically. Acceptance of and satisfaction with telehealth for ASD assessments in DBP were high for clinicians and most caregivers. Pros and cons concerning assessment quality and access to care were noted. Providers raised concerns about equity of telehealth access, particularly for families with a preferred language other than English. This study's results can inform the adoption of telehealth in DBP in an equitable manner beyond the pandemic. DBP providers and families desire the ability to choose telehealth care for different assessment components. Unique factors related to performing observational assessments of young children with developmental and behavioral concerns make telehealth particularly well-suited for DBP care.

Meeting the Behavioral Health Needs of Health Care Workers During COVID-19 by Leveraging Chatbot Technology: Development and Usability Study.

During the COVID-19 pandemic, health care systems were faced with the urgent need to implement strategies to address the behavioral health needs of health care workers. A primary concern of any large health care system is developing an easy-to-access, streamlined system of triage and support despite limited behavioral health resources. This study provides a detailed description of the design and implementation of a chatbot program designed to triage and facilitate access to behavioral health assessment and treatment for the workforce of a large academic medical center. The University of California, San Francisco (UCSF) Faculty, Staff, and Trainee Coping and Resiliency Program (UCSF Cope) aimed to provide timely access to a live telehealth navigator for triage and live telehealth assessment and treatment, curated web-based self-management tools, and nontreatment support groups for those experiencing stress related to their unique roles. In a public-private partnership, the UCSF Cope team built a chatbot to triage employees based on behavioral health needs. The chatbot is an algorithm-based, automated, and interactive artificial intelligence conversational tool that uses natural language understanding to engage users by presenting a series of questions with simple multiple-choice answers. The goal of each chatbot session was to guide users to services that were appropriate for their needs. Designers developed a chatbot data dashboard to identify and follow trends directly through the chatbot. Regarding other program elements, website user data were collected monthly and participant satisfaction was gathered for each nontreatment support group. The UCSF Cope chatbot was rapidly developed and launched on April 20, 2020. As of May 31, 2022, a total of 10.88% (3785/34,790) of employees accessed the technology. Among those reporting any form of psychological distress, 39.7% (708/1783) of employees requested in-person services, including those who had an existing provider. UCSF employees responded positively to all program elements. As of May 31, 2022, the UCSF Cope website had 615,334 unique users, with 66,585 unique views of webinars and 601,471 unique views of video shorts. All units across UCSF were reached by UCSF Cope staff for special interventions, with >40 units requesting these services. Town halls were particularly well received, with >80% of attendees reporting the experience as helpful. UCSF Cope used chatbot technology to incorporate individualized behavioral health triage, assessment, treatment, and general emotional support for an entire employee base (N=34,790). This level of triage for a population of this size would not have been possible without the use of chatbot technology. The UCSF Cope model has the potential to be scaled, adapted, and implemented across both academically and nonacademically affiliated medical settings.

Can tablet video-based telehealth assessment of the abdomen safely determine the need for abdominal imaging? A pilot study.

There is limited evidence on the reliability of video-based physical examinations. We aimed to evaluate the safety of a remote physician-directed abdominal examination using tablet-based video. This was a prospective observational pilot study of patients>19 years old presenting with abdominal pain to an academic emergency department July 9, 2021-December 21, 2021. In addition to usual care, patients had a tablet video-based telehealth history and examination by an emergency physician who was otherwise not involved in the visit. Both telehealth and in-person clinicians were asked about the patient's need for abdominal imaging (yes/no). Thirty-day chart review searched for subsequent ED visits, hospitalizations, and procedures. Our primary outcome was agreement between telehealth and in-person clinicians on imaging need. Our secondary outcome was potentially missed imaging by the telehealth physicians leading to morbidity or mortality. We used descriptive and bivariate analyses to examine characteristics associated with disagreement on imaging needs. Fifty-six patients were enrolled; the median age was 43 years (interquartile range: 27-59), 31 (55%) were female. The telehealth and in-person clinicians agreed on the need for imaging in 42 (75%) of the patients (95% confidence interval [CI]: 62%-86%), with moderate agreement with Cohen's kappa ((k=0.41, 95% CI: 0.15-0.67). For study patients who had a procedure within 24hours of ED arrival (n=3, 5.4%, 95% CI: 1.1%-14.9%) or within 30 days (n=7, 12.5%, 95% CI: 5.2%-24.1%), neither telehealth physicians nor in-person clinicians missed timely imaging. In this pilot study, telehealth physicians and in-person clinicians agreed on the need for imaging for the majority of patients with abdominal pain. Importantly, telehealth physicians did not miss the identification of imaging needs for patients requiring urgent or emergent surgery.

The Department of Veterans' Affairs Depleted Uranium Cohort in the Time of COVID-19: Translating a Traditional Surveillance Protocol to a Telehealth Platform.

In 2021, 37 members of a cohort of depleted uranium-exposed Gulf War I veterans were evaluated using a protocol tailored to accommodate COVID-19 safety practices on a telehealth platform. Individual elements of the legacy protocol were reviewed for urgency and feasibility of inclusion in a modified, telehealth platform. The redesigned protocol included a participant readiness for telehealth assessment, nurse and physician telehealth visits, collection of usual health questionnaires, and urine collections for exposure monitoring for uranium and other fragment-related metal measures. Despite some limitations in scope, the telehealth platform permitted a visual "visit" with surveillance participants who expressed a high comfort level with the format. The telehealth platform has apparent utility for occupational surveillance and should be explored as a standard approach for surveillance outside of public health emergencies.

Development and Validation of the Protocol for Administering Telehealth Home (PATH) Assessments.

Home safety assessments and subsequent modifications can prevent hospitalization, institutionalization, and death among older adults. Telehealth has been shown to be an effective means to administer home safety assessments. However, a structured approach to synchronous telehealth home assessments has not been examined. This study involved development and validation of a structured telehealth home assessment protocol. The Protocol for Administering Telehealth Home (PATH) assessment was developed based on literature review, clinical experience with in-person and telehealth home assessments, and interviews with content experts. Six older adults participated in the validation phase of the protocol using a quasi-experimental, mixed-methods, one-group research design. The validation process resulted in modifications to the protocol to enhance its utility in practice. The PATH protocol provides a valid, structured approach to conducting synchronous telehealth home assessments and can be used by occupational therapists to administer home assessments for older adults desiring to age in place.

Inter-rater agreement between 13 otolaryngologists to diagnose otitis media in Aboriginal and Torres Strait Islander children using a telehealth approach.

Telehealth programs are important to deliver otolaryngology services for Aboriginal and Torres Strait Islander children living in rural and remote areas, where distance and access to specialists is a critical factor. To evaluate the inter-rater agreement and value of increasing levels of clinical data (otoscopy with or without audiometry and in-field nurse impressions) to diagnose otitis media using a telehealth approach. Blinded, inter-rater reliability study. Ear health and hearing assessments collected from a statewide telehealth program for Indigenous children living in rural and remote areas of Queensland, Australia. Thirteen board-certified otolaryngologists independently reviewed 80 telehealth assessments from 65 Indigenous children (mean age 5.7±3.1 years, 33.8% female). Raters were provided increasing tiers of clinical data to assess concordance to the reference standard diagnosis: Tier A) otoscopic images alone, Tier B) otoscopic images plus tympanometry and category of hearing loss, and Tier C) as B plus static compliance, canal volume, pure-tone audiometry, and nurse impressions (otoscopic findings and presumed diagnosis). For each tier, raters were asked to determine which of the four diagnostic categories applied: normal aerated ear, acute otitis media (AOM), otitis media with effusion (OME), and chronic otitis media (COM). Proportion of agreement to the reference standard, prevalence-and-bias adjusted κ coefficients, mean difference in accuracy estimates between each tier of clinical data. Accuracy between raters and the reference standard increased with increased provision of clinical data (Tier A: 65% (95%CI: 63-68%), κ=0.53 (95%CI: 0.48-0.57); Tier B: 77% (95%CI: 74-79%), 0.68 (95%CI: 0.65-0.72); C: 85% (95%CI: 82-87%), 0.79 (95%CI: 0.76-0.82)). Classification accuracy significantly improved between Tier A to B (mean difference:12%, p<0.001) and between Tier B to C (mean difference: 8%, p<0.001). The largest improvement in classification accuracy was observed between Tier A and C (mean difference: 20%, p<0.001). Inter-rater agreement similarly improved with increasing provision of clinical data. There is substantial agreement between otolaryngologists to diagnose ear disease using electronically stored clinical data collected from telehealth assessments. The addition of audiometry, tympanometry and nurse impressions significantly improved expert accuracy and inter-rater agreement, compared to reviewing otoscopic images alone.

Telehealth Assessments and Interventions for Individuals With Poststroke Aphasia: A Scoping Review

There are increasing demands for aphasia assessment and intervention services to be delivered remotely. The purpose of this scoping review was to address what is known about the delivery of assessments and interventions using telehealth for people with poststroke aphasia. Specifically, the review sought to (a) identify which telehealth assessment protocols have been used, (b) identify which telehealth intervention protocols have been used, and (c) describe evidence on the effectiveness and feasibility of telehealth for people with poststroke aphasia. A scoping review of the literature published in English since 2013 was conducted by searching MEDLINE, Embase, PsycINFO, CINAHL, and Scopus databases to identify relevant studies. A total of 869 articles were identified. Two reviewers screened records independently, finding 25 articles eligible for inclusion. Data extraction was conducted once and validated by the second reviewer. Two of the included studies examined telehealth assessment protocols, whereas the remaining studies focused on the delivery of telehealth interventions. The results of the included studies illustrated both effectiveness and feasibility regarding telehealth for people with poststroke aphasia. However, a lack of procedural variation among the studies was found. Overall, this scoping review yielded continued support for the use of telehealth practices as an alternate mode of delivering both assessment and intervention services to people with poststroke aphasia. However, further research is needed to investigate the range of aphasia assessment and intervention protocols that can be offered via telehealth, such as assessments or interventions that use patient-reported measures or address extralinguistic cognitive abilities.

Telehealth Equivalence of the Montreal Cognitive Assessment (MoCA): Results from the Emory Healthy Brain Study (EHBS) (P6-6.001)

<h3>Objective:</h3> To characterize potential differences in Montreal Cognitive Assessment (MoCA) performance between in-person cognitive testing and video telehealth administration. In addition to global MoCA scores, we examined potential telehealth effects on mood (PHQ-8, GAD-7), and explored whether the presence of an observer at the participant’s home during remote MoCA testing influenced task performance. <h3>Background:</h3> Telehealth cognitive testing has become a common assessment approach following the COVID-19 pandemic when in-person testing was restricted for safety considerations. Although the equivalence of telehealth results to the traditional face-to-face testing is often assumed, formal equivalence validation is limited. <h3>Design/Methods:</h3> Scores from participants in the Emory Health Brain Study (EHBS) were contrasted based upon whether they were tested in the standard face-to-face (F2F) assessment (<i>n</i>=1205) or using a video telehealth administration (<i>n</i>=491). All EHBS participants were cognitively normal via self-report. <h3>Results:</h3> Total MoCA scores did not differ across administration method (F2F MoCA=26.6, <i>SD</i>=2.4, telehealth MoCA=26.5, <i>SD</i>=2.4). The 95% confidence interval for difference in administration was small (CI = −0.16 – 0.34). When examining individual MoCA domain scores, administration differences were either associated with no statistically significant effect, or if present were due to large sample sizes, were associated with small effect sizes and differences &lt; 0.5 point. Groups did not differ on GAD-7, although F2F patients reported slightly higher GAD-7 scores of 0.4 point but well within the normal range. The presence of an observer during telehealth testing did not influence MoCA scores. <h3>Conclusions:</h3> While no single study design provides complete evidence of task equivalence between in-person and video telehealth assessment, this report with its large sample size and between subject cohort provides reassurance that administration mode does not introduce systematic performance differences for MoCA test administration. Continuing studies in clinically impaired groups will be needed to demonstrate the robustness of our findings. <b>Disclosure:</b> Dr. Loring has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. Dr. Loring has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ILAE. The institution of Dr. Loring has received research support from NIH. Dr. Loring has received publishing royalties from a publication relating to health care. Dr. Lah has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche Diagnostics. The institution of Dr. Lah has received research support from Roche. Felicia Goldstein has nothing to disclose.

Health in the Skies: A Narrative Review of the Issues Faced by Commercial Airline Pilots.

While the health of airline pilots is crucial to ensuring the safe travel of millions of people worldwide, they remain vulnerable to a variety of health challenges due to the nature of their job. The purpose of this narrative review is to provide a comprehensive summary of the most common health issues experienced by commercial airline pilots. By examining the published literature on this topic, we sought to identify areas where further research is needed to understand better the health risks associated with being a pilot and to develop effective interventions to address these risks. We also highlight how recent technological advancesin digital health can be leveraged to conduct research into the potential usefulness of telehealth assessments for identifying occupational hazards in the aviation sector and providing targeted interventions. Overall, addressing the challenges of taking care of pilots' health and ensuring public safety will require a collaborative effort among airlines, governments, and regulators. Prioritizing pilot health and safety can actually improve profitability in the aviation sector by reducing costs associated with absenteeism, turnover, and accidents.

How good is the diagnostic test accuracy of telehealth assessment for dementia and mild cognitive impairment? A Cochrane Review summary with commentary.

It is estimated that 50% to 80% of people living with dementia worldwide remain undiagnosed and undocumented and have no access to care and treatment. Telehealth services can be utilized as one of the options to improve access to a diagnosis, especially for people living in rural areas or affected by COVID-19 containment measures. To assess the diagnostic accuracy of telehealth assessment for dementia and mild cognitive impairment (MCI). A summary of the Cochrane Review by McCleery et al. 2021, with comments from a rehabilitation perspective. Three cross-sectional diagnostic test accuracy studies (N = 136) were included. Participants were referred from primary care when presenting with cognitive symptoms or were identified as being at high risk of having dementia on a screening test in the care homes. The studies found that telehealth assessment correctly identified 80% to 100% of the people who were diagnosed with dementia during face-to-face assessment and also correctly identified 80% to 100% of people who did not have dementia. Only one study (N = 100) focused on MCI; 71% of participants who had MCI and 73% of participants who did not have MCI were correctly identified via telehealth assessment. Telehealth assessment in this study correctly identified 97% of the participants who had either MCI or dementia, but correctly identified only 22% of those who did not have either. Telehealth assessment for diagnosing dementia seems to have a good level of accuracy when compared to face-to-face assessment, although the small number of studies and small sample sizes and differences between the included studies indicate that the results are uncertain.

Assessment of Neurodevelopment in Infants With and Without Exposure to Asymptomatic or Mild Maternal SARS-CoV-2 Infection During Pregnancy

Associations between prenatal SARS-CoV-2 exposure and neurodevelopmental outcomes have substantial public health relevance. A previous study found no association between prenatal SARS-CoV-2 infection and parent-reported infant neurodevelopmental outcomes, but standardized observational assessments are needed to confirm this finding. To assess whether mild or asymptomatic maternal SARS-CoV-2 infection vs no infection during pregnancy is associated with infant neurodevelopmental differences at ages 5 to 11 months. This cohort study included infants of mothers from a single-site prospective cross-sectional study (COVID-19 Mother Baby Outcomes [COMBO] Initiative) of mother-infant dyads and a multisite prospective cohort study (Epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 in Pregnancy and Infancy [ESPI]) of pregnant individuals. A subset of ESPI participants was subsequently enrolled in the ESPI COMBO substudy. Participants in the ongoing COMBO study were enrolled beginning on May 26, 2020; participants in the ESPI study were enrolled from May 7 to November 3, 2021; and participants in the ESPI COMBO substudy were enrolled from August 2020 to March 2021. For the current analysis, infant neurodevelopment was assessed between March 2021 and June 2022. A total of 407 infants born to 403 mothers were enrolled (204 from Columbia University Irving Medical Center in New York, New York; 167 from the University of Utah in Salt Lake City; and 36 from the University of Alabama in Birmingham). Mothers of unexposed infants were approached for participation based on similar infant gestational age at birth, date of birth, sex, and mode of delivery to exposed infants. Maternal symptomatic or asymptomatic SARS-CoV-2 infection. Infant neurodevelopment was assessed using the Developmental Assessment of Young Children, second edition (DAYC-2), adapted for telehealth assessment. The primary outcome was age-adjusted standard scores on 5 DAYC-2 subdomains: cognitive, gross motor, fine motor, expressive language, and receptive language. Among 403 mothers, the mean (SD) maternal age at delivery was 32.1 (5.4) years; most mothers were of White race (240 [59.6%]) and non-Hispanic ethnicity (253 [62.8%]). Among 407 infants, 367 (90.2%) were born full term and 212 (52.1%) were male. Overall, 258 infants (63.4%) had no documented prenatal exposure to SARS-CoV-2 infection, 112 (27.5%) had confirmed prenatal exposure, and 37 (9.1%) had exposure before pregnancy or at an indeterminate time. In adjusted models, maternal SARS-CoV-2 infection during pregnancy was not associated with differences in cognitive (β = 0.31; 95% CI, -2.97 to 3.58), gross motor (β = 0.82; 95% CI, -1.34 to 2.99), fine motor (β = 0.36; 95% CI, -0.74 to 1.47), expressive language (β = -1.00; 95% CI, -4.02 to 2.02), or receptive language (β = 0.45; 95% CI, -2.15 to 3.04) DAYC-2 subdomain scores. Trimester of exposure and maternal symptom status were not associated with DAYC-2 subdomain scores. In this study, results of a novel telehealth-adapted observational neurodevelopmental assessment extended a previous finding of no association between prenatal exposure to maternal SARS-CoV-2 infection and infant neurodevelopment. Given the widespread and continued high prevalence of COVID-19, these data offer information that may be helpful for pregnant individuals who experience asymptomatic or mild SARS-CoV-2 infections.

Accelerating autism diagnosis using asynchronous telehealth technology

Background: Early identification and treatment of autism can prevent additional behavioral problems later in a child’s life. Long wait lists and travel limitations can often make it difficult for parents to obtain timely evaluations. A new telehealth technology has been developed that can provide clinicians with the ability to remotely observe a child’s behavior at home and allows parents to communicate with the clinician directly. The objective of this study was to compare the length of time from referral to the completion of a child’s diagnostic evaluation using asynchronous telehealth (TH) and using the traditional in-person assessment method (IPA). Methods: Three tertiary autism diagnostic centers in the United States conducted this study between 2016 and 2018. All three institutional review boards approved the research. Twenty-eight children were assigned to an IPA group and 29 children were assigned to a TH group. The IPA assessment was based on a standard in-person evaluation. Telehealth assessments used the naturalistic observation diagnostic assessment (NODA) system. Data were analyzed using SPSS. Required sample size was determined by power analysis. Results: For the three diagnostic centers, the average time from referral to completion of an autism diagnosis with IPA was 115 days and 66 days with telehealth. Conclusions: The NODA TH video-capture smartphone‐based technology offered a significant timesaving advantage for families seeking autism diagnostic services. The TH technology provided families located in remote areas with easier access to autism evaluations.

Creating opportunities for telehealth education, assessment, and care through Hotspotting (CO-TEACH): An interprofessional telehealth delivery curriculum and guide

Telehealth offers a healthcare solution when functional, social, or geographic barriers arise; however, many clinical education curricula are ill-equipped to prepare learners for effective, multidisciplinary telehealth consultations. The COVID-19 pandemic drastically expanded reliance on telehealth in clinical practice and highlighted the urgent need to educate students across health professions in telehealth delivery. To address this educational gap, student and faculty collaborators from Duke University and the University of North Carolina at Chapel Hill utilized a developmental evaluation approach to rapidly design and pilot a compact, five-session, virtual curriculum to train students from a broad range of health professions in telehealth delivery. Through focused readings, large group didactics, and small group discussion, the curriculum provided a general overview of telehealth, addressed specific issues in health equity and access in virtual care both locally and nationally, introduced skills for conducting telehealth visits, and employed a patient simulation for students to practice their newly learned skills. The curriculum was delivered virtually over eight weeks to 36 students from ten health professions programs (occupational therapy, social work, pharmacy, audiology, speech-language pathology, dentistry, medicine, nursing, physical therapy, and physician assistants) across two universities. End-of-course feedback surveys identified that students most valued the opportunity to work with learners from different professions, practical instruction for telehealth, and a standardized patient experience. On post-course surveys students reported high self-efficacy in their telehealth competencies and indicated very positive attitudes toward interprofessional education. Overall, the compact nature of this curriculum facilitates adaptability to other student-led groups.

Assessing calf exercise fidelity among people with Achilles tendinopathy using videos recorded via Zoom®: an observational study

Purpose Exercise fidelity is a fundamental aspect of exercise prescription by physiotherapists. Assessing exercise fidelity via telehealth (videoconference) is potentially useful but its reproducibility has not been assessed. The objective was to evaluate agreement (reproducibility) of video rating of calf exercise fidelity within (over four weeks) and between telehealth raters and compared with live rating. Methods Nineteen videos of participants with AT undertaking calf exercises were rated by physiotherapists in person (live) and by watching pre-recorded videos (replicating telehealth). Three forms of agreement were assessed: (i) between live assessment and recorded video (telehealth) assessment; (ii) between telehealth raters (inter-rater); (iii) agreement within telehealth raters over four weeks (intra-rater). Results There was weak to almost perfect agreement (Kappa = 0.65 to 1.00, rater 1, Kappa = 0.57 to 1.00, rater 2) between the telehealth and live raters. There was moderate to almost perfect agreement (Kappa = 0.65 to 1.00) when assessing intra-rater reliability, aside from one of the six criteria (quality of movement). Conclusion Assessing calf exercise fidelity via videos recorded on Zoom® appears to demonstrate weak or greater agreement versus live rating and over time. Inter-rater agreement was lower, suggesting that the criteria developed may be better suited to use by individual raters over time. Implications for rehabilitation Telehealth assessment (when compared with live, in person assessment) shows a moderate or greater agreement for the majority of assessment criteria when assessing calf exercise fidelity. The calf exercise fidelity criteria developed can be used as an adjunct to assessment and management of people with Achilles Tendinopathy. Intra-rater assessment was shown to be moderately or more consistent over a four-week period when assessing calf exercise fidelity.

Nurse Practitioner Follow-Up Care Using Telehealth MMSE.

During the COVID-19 pandemic, many healthcare services moved to telehealth delivery for continuation of care. The Mini Mental Status Examination (MMSE) has been used for follow-up assessment of disease progression and care planning after dementia diagnosis. Carotentuto et al. (2018) found no difference in MMSE scores when repeating a telehealth MMSE two weeks after a face-to-face visit. The purpose of this study was to determine if telehealth cognitive testing (MMSE) is a reliable alternative to traditional face-to-face testing when nurse practitioners are providing follow-up care (every 6 months) for person with dementia and their families. To evaluate MMSE testing administered via telehealth, a retrospective chart review of patients (N = 90) seen between April 2020 and December 2021 was conducted. Those fitting the inclusion criteria of at least two previous face-to-face MMSE assessments, and two MMSE telehealth assessments were analyzed (n = 45). Linear regression calculated the slope for each patient's MMSE score per year to compare the face-to-face and telehealth rates of cognitive decline for each individual. A paired t-test was used to compare MMSE slope for face-to-face and telehealth assessments. Although there was a larger decrease per year in MMSE score across telehealth assessments (during the pandemic) when compared to in-person (-2.7 vs -1.2, respectively), the difference in individual decline was not statistically significant (p = 0.10). There was also no significant difference between MMSE slope of decline in each of the two nurse practitioner providers for in-person testing mean (p = 0.32), telehealth mean (p = 0.34) and difference in slopes (p = 0.27). These preliminary findings indicate that administering the MMSE via telehealth does not result in scores that are markedly different from in-person testing. Therefore, it is reasonable to use telehealth for follow-up dementia care visits when an objective measure of cognitive decline is helpful to guide family caregiving. Telehealth may be a good alternative for patients and family who are unwilling or unable to travel to the clinic due to health concerns, poor weather, long travel time or agitation in a clinic setting, even when the pandemic has ended.

Understanding Clinician's Experiences with Implementation of a Younger Onset Dementia Telehealth Service.

The successful implementation of telehealth services depends largely on clinician acceptance of telehealth as a viable healthcare option and their adoption of telehealth methods into their clinical practice. While growing research supports the feasibility of telehealth services, no research has evaluated clinicians' experiences during the implementation of a younger onset dementia telehealth service. Semi-structured group interviews were conducted with 7 metropolitan (hub) clinicians and 16 rural (spoke) clinicians during the pre-and post-implementation phases of a novel Younger onset dementia (YOD) telehealth service. Reflexive thematic analysis identified five themes at pre-implementation: clinical need, previous experiences and views, potential telehealth barriers, solutions to potential telehealth barriers, and potential clinical outcomes. At post-implementation, nine themes were identified: clinical need, clinical relationships, concerns about the future of rural healthcare, clinical practice and resourcing factors, patient suitability, difficulties with technology, service quality, the way forward, and the impact of COVID-19. Most clinicians held positive views regarding the service, particularly the ability to provide more options to rural-dwelling patients. However, some concerns about threats to rural healthcare and the validity of telehealth assessments remained. Overall, this study has identified service implementation barriers and facilitators and contributes to the long-term sustainability of current and future telehealth YOD services.

Telehealth administration of narrative and procedural discourse: A UK and US comparison of traumatic brain injury and matched controls.

Impaired discourse production is commonly reported for individuals with traumatic brain injury (TBI). Discourse deficits can negatively impact community integration, return to employment and quality of life. COVID-19 restrictions have reduced in-person assessment services for people with communication impairments. Advances in telehealth may help speech and language therapists (SLTs) to assess monologic discourse more systematically and improve access to services for patients who may find it difficult to attend in-person. To examine the feasibility of telehealth administration of narrative and procedural discourse tasks with individuals with TBI and matched controls. A total of 20 individuals with TBI and 20 healthy controls, aged 18-55 years, were directly recruited from the UK and indirectly recruited from the US. For participants with TBI, time post-injury was at least 3 months with no diagnosis of aphasia. Control participants were matched for sex and as closely as possible for age. Feasibility of measures was based upon the time to administer both narrative tasks, the report of any technological problems, and participant feed. Discourse samples were transcribed verbatim and analysed using story grammar analysis (for narrative discourse) and identification of propositions (for procedural discourse). Interrater reliability was calculated using percentage agreement for 50% of the data. Non-parametric analyses were used to analyse the performance of the two groups. Narrative and procedural discourse samples were collected via telehealth in approximately 10 min with no reported technical difficulties or complaints from any participants. For narrative discourse performance, there were significant differences for the TBI and control groups for measures of complete episodes (p < 0.001) and missing episodes (p = 0.005). No significant group differences were noted for any of the procedural discourse measures. Results support the feasibility of collecting discourse samples via telehealth. Although the participants' discourse performance distinguished the TBI and control groups on the narrative task, no differences between the groups were noted for the procedural task. The narrative discourse task may have been more difficult than the procedural task, or video cue support reduced the cognitive load of the procedural task. This finding suggests the use of more complex procedural tasks without video cue support may be needed. What is already known on this subject Although littleresearch has explored the feasibility of administering discourse assessments for individuals with TBI via telehealth, some studies have found that discourse interventions can be feasibly administered via telehealth. It is also well established that individuals with TBI struggle with the supra-structural and macro-linguistic elements of discourse production. Both procedural and narrative discourse tasks have been found to differentiate individuals with TBI from healthy controls. What this paper adds to existing knowledge Few studies have investigated the feasibility of, and procedures for, administering discourse tasks via telehealth. Additionally, the inclusion of multiple types of discourse tasks to parse cognitive-communication abilities is lacking in the current literature. Findings from this study support that narrative and procedural discourse can be feasibly sampled via telehealth and that international collaboration for research on this topic can facilitate such studies. Individuals with TBI performed more poorly on three measures of narrative discourse. No differences between groups were identified for the procedural task. What are the potential or actual clinical implications of this work? Telehealth assessment for discourse provides flexibility for both the individual with TBI and the speech-language therapist and does not compromise the quality of data collected. The administration of discourse tasks and collection of data was not time-consuming and was well accepted by the study participants. Additionally, international research collaboration not only expands potential participation in research but increases the opportunity to recruit and study more diverse groups.

P111 Paediatric day-case adeno-tonsillectomy transfer to Hospital-in-the-Home: a new model of care

Abstract Aims Tonsillectomy and adenoidectomy (T&amp;A) is one of the most common paediatric surgical procedures. Post-operatively, children are monitored in hospital for bleeding, SpO2 desaturation, pain and oral intake. We report a new model of care for low-risk children undergoing T&amp;A to transfer to hospital-in-the-home (HITH) on the day of surgery, with the benefits of providing medically-supported recovery at home and reducing healthcare expenditure. Methods Children &amp;gt;/= 5yr, with normal pre-operative overnight oximetry, without co-morbidities/post-operative upper airway obstruction/bleeding and tolerating oral intake were eligible for HITH, between 4-6hr post-T&amp;A. Families were educated on administering adequate pain relief and oral intake. Overnight oximetry was monitored on the first night. Patients were reviewed at home day 1 then via telehealth day 2, before discharge. Results Sixteen patients with mean age 8.2yr (5-13yr) transferred to HITH post-day-case T&amp;A. There were no episodes of desaturation, bleeding or readmission. One patient presented to Emergency day 1 with fever, pain and vomiting, received symptomatic treatment and transfer back to HITH, with discharge day 2. Two patients required one additional telehealth assessment of hydration (1) and pain control (1) on day 3, before discharge. Conclusions This new model of care provides a safe, cost-saving, supported management pathway for low risk paediatric post-T&amp;A cohorts. Eligibility criteria will now expand as we increase virtual monitoring in the low risk cohort, freeing up HITH beds for younger and more complex post T&amp;A patients, and hospital beds for higher risk patients, enabling greater throughput for overwhelmed surgical wait lists.

Can We Expand the Pool of Youth Who Receive Telehealth Assessments for ADHD? Covariates of Service Utilization

Background: During the COVID-19 pandemic, telehealth became widely utilized for healthcare, including psychological evaluations. However, whether telehealth has reduced or exacerbated healthcare disparities for children with Attention-Deficit/Hyperactivity Disorder (ADHD) remains unclear. Methods: Data (race, ethnicity, age, insurance type, ADHD presentation, comorbidities, and distance to clinic) for youth with ADHD (Mage = 10.97, SDage = 3.42; 63.71% male; 51.62% White) were extracted from the medical record at an urban academic medical center. Three naturally occurring groups were compared: those evaluated in person prior to COVID-19 (n =780), in person during COVID-19 (n = 839), and via telehealth during COVID-19 (n = 638). Results: Children seen via telehealth were significantly more likely to be older, White, have fewer comorbid conditions, and live farther from the clinic than those seen in person. Conclusions: The current study suggests that telehealth has not eliminated barriers to care for disadvantaged populations. Providers and institutions must take action to encourage telehealth use among these groups.

Pediatric language assessments via telehealth: A systematic review

Introduction Assessment is crucial in the identification of children with potential delays/disorders and allows speech-language pathologists the opportunity to provide early intervention when indicated. For this reason, inaccessibility to formal assessments can be detrimental to the development and progression of overall communication skills for children with language disorders. The COVID-19 pandemic highlighted the need for increased telehealth services and how the provision of these remote services offers a much-needed alternative to face-to-face services for both clinicians and families. Method A systematic procedure involving online literature searches in four electronic databases was employed to identify studies for inclusion in this review. Inclusion criteria were as follows: (1) preschool or elementary pediatric participants, and (2) involve the delivery of language-based assessments via telehealth. Additionally, the search was limited to studies written in English, dated 2010 and newer, and published in peer-reviewed journals. Results The results of the systematic review showed there was no significant difference between standard scores and behavioral ratings for both face-to-face and telehealth assessments. The studies reviewed determined that telehealth delivery was feasible and presented adequate reliability with high levels of agreement between assessment scores obtained via telehealth and face-to-face. Conclusion Current research suggests that there is no significant difference between remote and face-to-face assessment administration. Additional research is needed to examine the feasibility and reliability of conducting language-based assessments via telehealth in bilingual children, children younger than four years of age, and in different environments, such as schools or clinics.