Virtual Care Models Research Articles

A Virtual Hybrid Care Hotel Model Supports the Recovery of Post-procedural Patients with Mild to Severe Systemic Diseases.

Patients with mild to severe chronic systemic disease undergoing low-risk procedures are often hospitalized for observation. The Care Hotel is a novel virtual medicine hybrid model of care that offers patients a comfortable, out of hospital environment where they can receive both in-person and virtual care after a surgery or procedure. This study aimed to analyze if virtual hybrid post-procedure care in a hotel could be both conducted on and accepted by patients, even those with moderate to severe chronic diseases. This retrospective cohort study was conducted between July 23, 2020 and June 4, 2021 at Mayo Clinic in Florida, a 306-bed community academic hospital. We collected the sex, age, race, ethnicity, acceptance rate, ASA score, and primary procedure of patients using the Care Hotel. Out of 392 patients, 272 (69.4%) opted for care in the program. Median patient age was 61.5 years, 59.56% were males, and 86.40% were white. We found that 50.37% had an ASA score of 2 and 43.4% had an ASA score of 3. Ten different surgical specialties were able to utilize the Care Hotel for care in 47 different procedure types. Urology had the most patients (n=70, 25.7%). Post-electrophysiologic procedures were the most common procedures (n=39, 14.3%). Our virtual hybrid Care Hotel program was widely accepted by patients and could care for a multitude of post-operative procedures. Additionally, this novel program can care for patients with both mild and severe systemic diseases.

Virtual Endocrinology Care Emphasizing Data-Driven Insights and Continuous Engagement and Its Impact on Glycemic Outcomes in Patients With Uncontrolled Diabetes: A Real-world Retrospective Case Series.

BackgroundSteady Health’s novel virtual care model incorporates continuous glucose monitoring (CGM) and a multidisciplinary approach to timely person-centered diabetes care.ObjectiveThis real-world retrospective case series explores the early glycemic outcomes of its patients with uncontrolled diabetes.MethodsAll patients of Steady Health who had an initial time in range (TIR) below 70% from their first 4 weeks of available CGM data and who had completed onboarding by February 2021 were included in this analysis. We compared the change in TIR, time below range, and average blood glucose from their first 4 weeks with their latest 4 weeks of available CGM data. Hemoglobin A1c (HbA1c) values at baseline and at the end of the study were also compared. Patients completed a questionnaire assessing their satisfaction with Steady Health’s intervention.ResultsA total of 53 patients (n=35, 66% with type 1 diabetes; n=44, 83% treated with insulin) were included in this analysis. This cohort had a median baseline TIR of 53.0% (IQR 40.9%, 61.7%) and saw a median change in TIR of +16.6% (IQR +6.0%, +27.9%; P<.001) over a median duration of care of 11 months, amounting to nearly 4 more hours spent between 70 to 180 mg/dL a day. Of the 27 patients who had both baseline and follow-up HbA1c results, their median baseline HbA1c was 8.6% (IQR 7.5%, 11.4%; 70 mmol/mol), while their median change in HbA1c was –1.2% (IQR –2.6%, –0.2%; P=.001). Importantly, these glycemic improvements were achieved with a median decrease in the time below range by –0.3% (IQR –1.1%, 0.0%; P<.001), regardless of whether patients were started on an automated insulin delivery system. A total of 40 (75.5%) patients improved TIR by ≥5%, and 27 (50.9%) achieved TIR≥70% by the end of the study. Glycemic improvements were greatest among patients with the lowest baseline TIR and those who collaborated most intensively with Steady Health’s clinicians. A total of 25 of these patients responded to a questionnaire assessing levels of satisfaction with their care, and all of them agreed that Steady Health had a positive impact on their diabetes management.ConclusionsOur findings suggest that patients with uncontrolled diabetes can achieve significant glycemic improvements by working with a virtual multidisciplinary care team that uses CGM to provide continuous clinical feedback and support.

Can Teledentistry Replace Conventional Clinical Follow-Up Care for Minor Dental Surgery? A Prospective Randomized Clinical Trial.

(1) Background: Born out of necessity, the implementation of digital processes experienced significant increase during the COVID-19 pandemic. Here, telemedicine offered a bridge to care and now an opportunity to reinvent virtual and hybrid care models, with the goal of improved healthcare access, outcomes, and affordability. The aim of this monocentric prospective, randomized trial was to compare conventional to telephone follow-up after minor dentoalveolar surgery on the basis of special aftercare questionnaires. (2) Methods: Sixty patients who underwent dentoalveolar surgery under local anesthesia were randomly assigned to both groups. After an average of four days, either telephone follow-up (test) or conventional personal aftercare (control) was performed. Based on the questionnaire, the following subject areas were evaluated: symptoms, complications, satisfaction with practitioner, travel, and waiting time, as well as the preferred form of follow-up care. (3) Results: There was no statistically significant difference regarding frequency of symptoms or complication rate. Patients who were assigned to the test group showed a clear tendency to prefer telephone follow-up (83.3%) to conventional aftercare (16.7%, p = 0.047). (4) Conclusions: The data suggest high acceptance of telephone-only follow-up after dentoalveolar surgery. The implementation of telemedicine could be a time- and money-saving alternative for both patients and healthcare professionals and provide healthcare access regardless of time and space.

Pharmacists' impact on quality and financial metrics utilizing virtual care platforms during the coronavirus pandemic.

PurposeBecause of rising concern about coronavirus disease 2019 transmission, there has been a large shift from face-to-face, in-office visits to a virtual care model. The purpose of this article is to explain how Ascension Florida Gulf Coast was able to maximize the utility of ambulatory care pharmacists (ACPs) in the primary care setting during the pandemic and to provide guidance for creating a sustainable billing and practice model in the event of another global health crisis.SummaryBy employing telehealth services, our ACPs were able to continue to co-manage chronic disease states for documented diagnoses while still maintaining health-system revenue in the midst of a global health crisis. Utilizing various virtual platforms, ACPs were able to accommodate the needs of our patients while addressing concerns related to the compatibility and user friendliness of the platforms for our diverse patient population. ACPs used traditional incident-to evaluation and management services current procedural terminology billing codes with a virtual visit modifier for billing and tracking purposes.ConclusionUtilizing various virtual care platforms, our ACPs completed 447 patient encounters within the first 7 months of the pandemic. During this time, our ACPs addressed various population health metrics, specifically for patients diagnosed with diabetes without an active claim for a cholesterol-lowering medication, in addition to performing chronic disease management. Our ACPs had a 23% success rate for statin initiation in patients reviewed and contacted. By adopting virtual care options, our ACPs were able to effectively co-manage and educate patients while improving quality metrics and generating $50,662.24 in billable encounters for the health system during a global health crisis. The addition of ACP virtual encounters to primary care clinics both increases access to healthcare and improves patient care quality and outcomes while limiting revenue losses in our local health system.

Provider Evaluation of a Novel Virtual Hybrid Hospital at Home Model.

BackgroundHealthcare provider’s experience with new models of care is crucial for long-term success. In July 2020, Mayo Clinic implemented a novel virtual hybrid hospital at home program called Advanced Care at Home (ACH). This model allows virtual providers in a command center to care for high-acuity patients in the home setting through collaboration with a vendor-mediated supply chain. This study aims to describe the outcomes obtained from a survey applied to the ACH providers to determine their acceptance of the quality and safety of the virtual hybrid care model, their perception towards the decision-making and teamwork between the command center and supplier network, and determine if the overall experience with ACH was rewarding.MethodsA 15-question anonymous survey was distributed via email quarterly to all the physicians and nurse practitioners registered in ACH program at Mayo Clinic. The survey encompassed questions related to the overall experience in ACH concerning work environment, quality of care, service reliability, teamwork, decision-making, and satisfaction. All the questions were Likert-like scale choice, and a descriptive analysis using frequency distribution and percentages of the data was performed.ResultsBetween September 1, 2020 and April 30, 2021, three quarterly surveys were sent to a total of 21 physicians and nurse practitioners caring for patients virtually in ACH. The response rate reported was 72%, 33%, and 66%, respectively, at the first, second, and third quarters. Eighty percent or more of providers consistently gave positive scores to all three areas analyzed throughout the 8-month study.ConclusionProviders found the ACH virtual hybrid model of home hospital care very rewarding. They were able to deliver high-quality and safe care to their patients through positive teamwork with a vendor-mediated supply chain. This novel model of hospital at home has the potential to be a great provider satisfier moving forward.

Surgical patient satisfaction with a virtual hybrid care hotel model: A retrospective cohort study

IntroductionThe Care Hotel is a virtual medicine hybrid model of care that was implemented at Mayo Clinic in Florida in July of 2020. This temporal accommodation offers patients a comfortable out of hospital environment where they can receive both in-person and virtual care after a surgery or procedure. This study aims to report patient feedback regarding their Care Hotel experience. Materials and methodsBetween July 23, 2020 and June 4, 2021, a satisfaction survey was sent to patients via email after their discharge from the Care Hotel. The survey consisted of 8 Likert questions rating their experience in the model as well as 2 questions where patients describe the positive and negative aspects of their stay. Patient demographics including age, sex, procedure performed, and the surgical/procedural service under which they were admitted to the hotel were also collected. ResultsOut of 182 patients admitted to Care Hotel, 102 answered the survey. Nine surveys were excluded due to missing patient information, and 93 surveys were analyzed. Eighty-seven percent of patients had a positive experience in the Care Hotel model and 94% of patients were likely to recommend the program to others. Positive comments highlighted the ease of use of the technology setups, the low cost of the hotel, the seamless transition of care, and the relief of the burden of care for family members. ConclusionThe Mayo Clinic hybrid Care Hotel, combining both in-person and virtual modes of medical care, provides a good overall experience for patients following low-risk surgeries and procedures.

Modifying UTAUT2 for a cross-country comparison of telemedicine adoption

The ongoing COVID19 pandemic has put digital health technologies in the spotlight. To gain a deeper understanding of patients’ usage intentions of virtual doctor appointments, the present research adapts the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) by integrating perceived security and perceived product advantage, two known barriers to successful telemedicine adoption. Applying age-stratified sampling, an online survey was distributed to 800 citizens in Germany and the United States of America. 710 completed and valid questionnaires were subsequently analyzed using SPSS and AMOS (versions 24).Significant, direct, and positive effects of performance expectancy, hedonic motivation, perceived security, and perceived product advantage on the behavioral intention to use virtual doctor appointments were found. The analysis of the moderating variables, age and gender, showed significant differences in user's performance expectancy and effort expectancy, and perceived product advantage, respectively. With virtual health care models on the rise, these results are important for stakeholders such as policymakers, governments, employers, but also physicians, and insurance companies as they offer clear recommendations to design telemedicine adoption strategies to ensure successful patient engagement.

How Do Virtual Visits Compare? Parent Satisfaction With Pediatric Diabetes Telehealth During the COVID-19 Pandemic.

In response to the COVID-19 pandemic, many countries relaxed restrictions on telemedicine, allowing for a robust transition to virtual visits for routine care. In response, centers rapidly instituted and scaled telemedicine for pediatric diabetes care. Despite numerous center reports on their experience, little is known about parent perspectives on the widespread increase of telemedicine for pediatric diabetes appointments. To assess parent satisfaction with virtual care for pediatric diabetes during the COVID-19 pandemic. We conducted an online, cross-sectional survey of parents of youth with diabetes who receive care at a large, academic diabetes center regarding their perspectives on newly introduced virtual appointments. Parents were surveyed at two time points during the pandemic using a validated scale which was adapted for diabetes. We explored demographic and clinical factors which may influence parental satisfaction. Overall, parents expressed high levels of satisfaction (>90%) with functional aspects of the visit, though only approximately half (56%) felt the visit was as good as an in-person encounter. Nearly three-quarters (74%) would consider using telemedicine again in the future. Prior use of telemedicine significantly influenced parent satisfaction, suggesting that parent preferences may play a role in continued use of telemedicine in the future. There was no difference in responses across the two timepoints, suggesting high satisfaction early in the pandemic which persisted. If permissive policies for telemedicine continue, diabetes centers could adopt hybrid in-person and virtual care models, while considering various stakeholder perspectives (providers and patients) and equity in access to virtual care.

Use and impact of virtual primary care on quality and safety: The public's perspectives during the COVID-19 pandemic

Introduction With the onset of Coronavirus disease (COVID-19), primary care has swiftly transitioned from face-to-face to virtual care, yet it remains largely unknown how this has impacted the quality and safety of care. We aim to evaluate patient use of virtual primary care models during COVID-19, including change in uptake, perceived impact on the quality and safety of care and willingness of future use. Methodology An online cross-sectional survey was administered to the public across the United Kingdom, Sweden, Italy and Germany. McNemar tests were conducted to test pre- and post-pandemic differences in uptake for each technology. One-way analysis of variance was conducted to examine patient experience ratings and perceived impacts on healthcare quality and safety across demographic characteristics. Results Respondents (n = 6326) reported an increased use of telephone consultations ( + 6.3%, p < .001), patient-initiated services ( + 1.5%, n = 98, p < 0.001), video consultations ( + 1.4%, p < .001), remote triage ( + 1.3, p < 0.001) and secure messaging systems ( + 0.9%, p = .019). Experience rates using virtual care technologies were higher for men (2.4 ± 1.0 vs. 2.3 ± 0.9, p < .001), those with higher literacy (2.8 ± 1.0 vs. 2.3 ± 0.9, p < .001), and participants from Germany (2.5 ± 0.9, p < .001). Healthcare timeliness and efficiency were the dimensions most often reported as being positively impacted by virtual technologies (60.2%, n = 2793 and 55.7%, n = 2,401, respectively), followed by effectiveness (46.5%, n = 1802), safety (45.5%, n = 1822), patient-centredness (45.2%, n = 45.2) and equity (42.9%, n = 1726). Interest in future use was highest for telephone consultations (55.9%), patient-initiated digital services (56.1%), secure messaging systems (43.4%), online triage (35.1%), video consultations (37.0%) and chat consultations (30.1%), although significant variation was observed between countries and patient characteristics. Discussion Future work must examine the drivers and determinants of positive experiences using remote care to co-create a supportive environment that ensures equitable adoption and use. Comparative analysis between countries and health systems offers the opportunity for policymakers to learn from best practices internationally.

Current provision and HCP experiences of remote care delivery and diabetes technology training for people with type 1 diabetes in the UK during the COVID-19 pandemic.

The COVID-19 pandemic has led to the rapid implementation of remote care delivery in type 1 diabetes. We studied current modes of care delivery, healthcare professional experiences and impact on insulin pump training in type 1 diabetes care in the United Kingdom (UK). The UK Diabetes Technology Network designed a 48-question survey aimed at healthcare professionals providing care in type 1 diabetes. One hundred and forty-three healthcare professionals (48% diabetes physicians, 52% diabetes educators and 88% working in adult services) from approximately 75 UK centres (52% university hospitals, 46% general and community hospitals), responded to the survey. Telephone consultations were the main modality of care delivery. There was a higher reported time taken for video consultations versus telephone (p<0.001). Common barriers to remote consultations were patient familiarity with technology (72%) and access to patient device data (67%). We assessed the impact on insulin pump training. A reduction in total new pump starts (73%) and renewals (61%) was highlighted. Common barriers included patient digital literacy (61%), limited healthcare professional experience (46%) and time required per patient (44%). When grouped according to size of insulin pump service, pump starts and renewals in larger services were less impacted by the pandemic compared to smaller services. This survey highlights UK healthcare professional experiences of remote care delivery. While supportive of virtual care models, a number of factors highlighted, especially patient digital literacy, need to be addressed to improve virtual care delivery and device training.

102 Virtual family-centered rounds: A collaborative necessity during COVID-19 and beyond

Primary Subject areaHospital PaediatricsBackgroundFamily-centered rounds (FCR) are the cornerstone of pediatric hospital care and have many proven benefits including improved patient outcomes, satisfaction, communication and safety. Traditionally, FCR take place in the patient’s room; however, due the COVID-19 pandemic, entering patient rooms was no longer advisable in order to maintain physical distancing and preserve personal protective equipment (PPE). Therefore, it became clear early in our pandemic response that a new process was required to ensure the benefits of FCR were maintained given their paramount importance to safe and quality patient care.ObjectivesThe objective of this study was to virtualize the in-person FCR process used by our pediatric inpatient medicine teams to improve safety and reduce PPE costs during the COVID-19 pandemic.Design/MethodsWe quickly identified available hardware (laptops, tablets) and video conferencing software, assembled a multidisciplinary project team and secured administrative and quality improvement support. Quality improvement methodology and participatory design were used to develop and refine our virtual family-centered rounds (vFCR) standard work, and on April 6, 2020 we launched our first vFCR. Over the next 3 months we engaged in a series of plan-do-study-act (PDSA) cycles to iteratively improve our process: nurse auditors attended vFCR daily then met with our project team to review data and observations, and real-time feedback was sought from patients and caregivers.ResultsData collected on 1792 vFCR between April 6 and July 31, 2020 revealed 74% of nurses, physicians and trainees were satisfied or very satisfied with vFCR and 88% felt they had a good understanding of the patient care plan after vFCR. 79% of patients and caregivers were satisfied or very satisfied with vFCR and 88% of caregivers felt like a valued member of their child’s care team. We met our target of 10 minutes per patient in 74% of vFCR with an average transition time of <3 minutes between patients. Patients and caregivers felt vFCR were collaborative, more private and less intimidating than in-person FCR, and some even preferred the virtual approach.ConclusionDuring this pilot, we achieved a standardized vFCR workflow that is safe, feasible, efficient and confidential, with high levels of stakeholder satisfaction and support. vFCR was highly valued by families and yielded unanticipated benefits. Based on current usage, vFCR are saving ~$36,000 monthly in PPE. The importance of this work during the COVID-19 pandemic is clear, but also has benefits in non-pandemic times, including allowing caregivers to participate in FCR when they cannot be at the bedside, enhancing FCR confidentiality, and improving communication and care for isolated patients. Furthermore, the vFCR process is easily adaptable to other inpatient workflows such as consults and multi-disciplinary meetings. We believe this virtual care model is both highly relevant and transferable to a variety of health care settings across Canada and beyond.

Virtual Round care model in a Covid-19 Geriatric sub intensive unit

Introduction. Telepresence provides clinicians the ability to monitor patients as well to communicate with all the members of the healthcare staff. Covid-19 Units cope with high complexity in providing care and an integration amount the care team and the patients’ relatives should be carried out to obtained successful outcomes and preventing complication. Virtual rounding (VR) has been successfully applied to cope with this task in the last 2000 years in medical units. Covid-19 patients due to safety rules may be prone to isolation and lack of communication with their family.&#x0D; Purpose. The aim of our study was to evaluate the effect of structured virtual round protocol in a geriatric Covid-19 unit on anxiety and depression for the patients and their relatives.&#x0D; Methodology. All the patients admitted to the geriatric Covid-19 unit from 1 February 2021 to 30 April were studied. Inclusion criteria to the study were the followings: no severe cognitive impairment (MMSE =&gt;24) or neuro sensorial deficits; informed consent to participate to the study. Forty-nine 49 (75% of patients) met the inclusion criteria. All the subject who were found to be eligible to the study underwent a VR standard protocol of care. VR was consisted with: 1) a video call with a tablet device conducted by a psychologist that established a cooperative communication between the health care staff (nurses and MD, their relatives) at the bed sides; 2) a video call with the patient’s relatives in which it was clearly explained the standard care and the role of each healthcare member was also included. Anxiety and depression levels were assessed for the patients at baseline after the end of the protocol by the Hospital Anxiety and Depression Scale (HADS). Patients’ relatives were investigated for depression at baseline and after the end of the protocol by the Beck Depression Inventory- Primary Care (BDI-PC). The Beck Depression Inventory for primary care has seven items with each item rated on a 4-point scale (0–3). It is scored by summing ratings for each item (range 0–21). Items are symptoms of sadness, pessimism, past failure, loss of pleasure, self-dislike, self-criticalness, and suicidal thoughts and wishes. The Hospital Anxiety and Depression Scale (HADS) is a self- assessment scale found to be a reliable instrument for detecting states of depression and anxiety. The anxiety and depressive sub-scales are also valid measures of severity of the emotional disorder. The questionnaire comprises seven questions for anxiety and seven questions for depression, and takes 2–5min to complete. For both scales, scores less than 7 indicate non- cases, 8-10 mild, 11-14 moderate, 15-21 severe. JMP software by SAS (v.16) was used for the statistical analysis.&#x0D; Results. The present study included forty-nine 49 patients (67% male), mean age of 69.9 ±14.7 years with one relative for each patient. The average mean of the hospitalization for each patients was 17.6 ± 5.7 days The mean VR duration time was 60±5.5 minutes. VR showed a significant decrease in both Anxiety and depression for patients: (HADS Depression baseline 10.6 ±3.1 vs 6.9 ±2.7 end p&lt;0.01) (HADS Anxiety baseline 10.2 ±3.4 vs 6.8 ±3.0 end p&lt;0.01). VR has also reduced depression in the relatives of patients (BDI-PC 3.6 ±2.4 vs 1.9 ±1.9 p&lt;0.01).&#x0D; Discussion. VR has reduced anxiety and depression in patients hospitalized in a sub-intensive COVID 19 unit and it also has been found to be effective in decreasing depression in the relatives of these patients&#x0D; Limitation. However, the study has some possible limitations considering its small size and that it was mono centric&#x0D; Conclusions. Our data confirm the efficacy of VR in the sub-intensive care setting. This evidence supports the key role of a multidisciplinary team, focusing on the importance of social and psychological support during the hospital stay. &#x0D; More studies will be consequently necessary to better validate the importance of VR as a standard care tool in intensive/sub- intensive care units for the elderly patients

Virtual Respiratory Urgent Clinics for COVID-19 Symptoms.

The COVID-19 pandemic has forced a shift from in-person to virtual care to reduce exposure risks to patients and health care workers. This report aims to describe a large primary care system's implementation of virtual respiratory urgent care clinics (VRUCs). The VA Connecticut Healthcare System (VACHS) delivers care to more than 58,000 veterans in at 8 primary care sites. VRUCs were established as part of the VACHS primary care rapid transition to virtual care model. Retrospective analysis and qualitative chart reviews were performed from February 2020 through May 2020 to describe characteristics of patients who received care through the VRUCs. VRUCs were used by > 445 patients, 51% received COVID-19 testing, 10% tested positive, 5% were admitted to the hospital, and 18% had ≥ 1 subsequent emergency department visits. Chart documentation rates of discussion of isolation precautions, high occupational risk, and goals of care were 71%, 25%, and 14%, respectively. Average wait time for health care provider evaluation was 104 minutes, suggesting VRUCs are an expedient means to provide assessment of COVID-19 symptoms. Use of templated notes may ensure routine counseling about isolation, occupation, and goals of care.

Initial Outcomes of CardioClick, a Telehealth Program for Preventive Cardiac Care: Observational Study.

BackgroundTelehealth use has increased in specialty clinics, but there is limited evidence on the outcomes of telehealth in primary cardiovascular disease (CVD) prevention.ObjectiveThe objective of this study was to evaluate the initial outcomes of CardioClick, a telehealth primary CVD prevention program.MethodsIn 2017, the Stanford South Asian Translational Heart Initiative (a preventive cardiology clinic focused on high-risk South Asian patients) introduced CardioClick, which is a clinical pathway replacing in-person follow-up visits with video visits. We assessed patient engagement and changes in CVD risk factors in CardioClick patients and in a historical in-person cohort from the same clinic.ResultsIn this study, 118 CardioClick patients and 441 patients who received in-person care were included. CardioClick patients were more likely to complete the clinic’s CVD prevention program (76/118, 64.4% vs 173/441, 39.2%, respectively; P<.001) and they did so in lesser time (mean, 250 days vs 307 days, respectively; P<.001) than the patients in the historical in-person cohort. Patients who completed the CardioClick program achieved reductions in CVD risk factors, including blood pressure, lipid concentrations, and BMI, which matched or exceeded those observed in the historical in-person cohort.ConclusionsTelehealth can be used to deliver care effectively in a preventive cardiology clinic setting and may result in increased patient engagement. Further studies on telehealth outcomes are needed to determine the optimal role of virtual care models across diverse preventive medicine clinics.

‘Empowering clinicians in smaller sites’: A qualitative study of clinician's experiences with a rural Virtual Paediatric Feeding Clinic

To explore the experiences of 'spoke site' allied health and child and family health clinicians in the provision of care through a pilot 'hub and spoke' model Virtual Paediatric Feeding Clinic (VPFC) outreach service. The study was qualitative, with data from virtual interview transcripts analysed using thematic analysis. Orange Health Service ('hub site') and seven community health centres within the Western NSW Local Health District ('spoke sites'). Nine 'spoke site' clinicians (from dietetics, speech pathology, occupational therapy and child and family health nursing), who had participated in the pilot clinic. Participants took part in a semi-structured interview with a member of the research team. Spoke site clinicians experiences and perceptions of the VPFC. Four key themes emerged: (1) impact of the VPFC on 'spoke site' clinicians, (2) benefits for clients and families, (3) perceptions of the virtual model of care and (4) VPFC service challenges. The expansion of an existing interdisciplinary Paediatric Feeding Clinic into a virtual service demonstrates the use of technology to bridge a gap in healthcare. Clinicians reported benefits not only for families, but for their own knowledge and confidence in provision of care and reduced professional isolation through connection with discipline-specific colleagues.

Management of Frail and Older Homebound Patients With Heart Failure: A Contemporary Virtual Ambulatory Model

BackgroundHeart failure (HF) affects many patients who are older and frail, presenting multiple physical barriers to accessing specialty care in a traditional ambulatory clinic model. Here, we present an assisted virtual care model in which a home visiting nurse facilitated video visits with a HF cardiologist to follow homebound, frail, and older patients with HF. MethodsThis is a pragmatic, quasi-experimental, pre–post, single-centre study. It included homebound, frail, and older patients with HF from 2015 to 2019 who were followed for 1 year; in-person clinic visits were completely replaced by nurse-facilitated virtual video visits. Outcomes evaluated included annualized hospitalization rate, number of hospitalization days, and number of emergency department visits. ResultsA total of 49 patients were included, with a median age of 86 (83-93) years, and were followed for 1 year after enrollment. Among patients enrolled, HF with preserved ejection fraction was the most common subtype (57%). Compared to the year prior to enrollment, patients had a lower mortality-adjusted all-cause annualized hospitalization rate in the year following enrollment (2.57 vs 1.78, P < 0.0001). Compared to the year prior, the number of mortality-adjusted all-cause hospitalization days was significantly lower in the year following enrollment (27.2 vs 21.4, P < 0.0001). There was a reduction in the number of all-cause annualized emergency department visits (3.10 vs 2.27, P = 0.003). ConclusionsNurse-assisted virtual visits may be a preferable strategy for homebound, frail, and older patients with HF to receive longitudinal care. This approach may represent a plausible strategy to care for other patients with significant barriers to accessing specialized cardiac care.

Implementation and Monitoring of a Telemedicine Model in Acromegalic Outpatients in a Low-Income Country During the COVID-19 Pandemic.

Background: Telemedicine is a resource to provide health care to patients social distancing and prevent their exposure to the risk of contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in medical-hospital settings. This study evaluated a virtual model of care in acromegalic patients. Methods: We recruited 78 acromegalic patients, 65% female, median age 63 years. Outpatient management was remodeled to simplify access to care by (1) adoption of virtual meetings; (2) collection of blood samples at home; (3) abolishment of printed prescription and provision of electronic files directly to central pharmacy; and (4) drugs delivered to patients' home. Patients and physicians filled electronic surveys 48 h after each consultation. Results: The patients expressed satisfaction with convenience (91.1%), decreased wait time (85.1%), and saving money (79.2%) compared to face-to-face visits. Most patients felt supported by the medical team (89.1%) and kept the prescriptions updated (84.8%). The physicians reported resolutive appointments in 92.2% of cases, despite longer time to reach the patients and subsequent calls to complement missing information. Satisfaction and patient-provider relationship were maintained during the study, but the choice for virtual appointment for the next appointment fell from 78.7% to 34.8% after 6 months. Coronavirus disease 2019 (COVID-19) was confirmed in 13% of patients, mostly mild and moderate manifestations. Conclusion: Telemedicine is a tool for medical care in underserved populations, feasible even in low-income countries. This study suggests that it is difficult to sustain exclusive remote care for more than 6 months. The method could be adopted interchangeably with in-person consultations in acromegalic patients with stable disease.

Provider experience and satisfaction with a novel 'virtual team rounding' program during the COVID-19 pandemic.

New inpatient virtual care models have proliferated in response to the challenges presented by the coronavirusdisease 2019 (COVID-19) pandemic; however, few of these programs have yet been evaluated for acceptability and feasibility. Assess feasibility and provider experience with the Virtual Team Rounding Program (VTRP), a quality improvement project developed and rapidly scaled at Brigham and Women's Hospital in Boston, MA, in response to the surge of COVID-19 patients in the spring of 2020. We surveyed 777 inpatient providers and 41 providers who served as 'virtual rounders' regarding their experience with the program. Inpatient providers were asked about their overall satisfaction with the program, whether the program saved them time, and if so, how much and their interest in working with a similar program in the future. Providers who had worked as virtual rounders were asked about their overall satisfaction with the program, the overall difficulty of the work and their interest in participating in a similar program in the future. We find that among both groups the program was well-received, with 72.5% of inpatient providers and 85.7% of virtual rounders reporting that they were 'satisfied' or 'very satisfied' with their experience with the program. Among inpatient providers who worked with the program, two-thirds reported the program saved them time on a daily basis. Inpatient respondents who had worked with virtual rounders were more likely to say that they would be interested in working with the VTRP in the future compared with respondents who never worked with a virtual rounder (75.3 vs 52.5%, P < 0.001). As the pandemic continues, rapidly implementing and studying virtual care delivery programs is crucial for hospitals and health systems. We demonstrate the feasibility and acceptability of a 'virtual rounding' program assisting inpatient providers. Future work should examine the impact of these programs on patient outcomes.

The Secret of Serotinous Leadership:: The Pandemic Crisis Changed Care Models, But Only After Leaders Changed Their Minds About Them

The COVID-19 pandemic punctured the status quo, triggering a reassessment of mindsets, biases and assumptions that had impeded widespread adoption of virtual care models and advanced nursing practice roles within them. Now, as we move to a post-pandemic environment, we enter a new phase, one in which continued progress on these fronts is not assured. Formalizing these breakthroughs as new standards of care - and securing nurses’ expanded practice roles - rests on the ability of nurse leaders to address a phenomenon called “cultural lag” and imaginatively shape the transformation on which continued progress depends.

Challenges and opportunities during the COVID-19 pandemic: Treating patients for substance use disorders during the perinatal period

The coronavirus disease 2019 (COVID-19) pandemic exacerbated the opioid use disorder epidemic and accelerated alcohol and other substance use disorders. Sudden health care service delivery changes during the COVID-19 pandemic created both challenges and opportunities for all patients with substance use disorders including the use of virtual or telemedicine visits, medication access issues and ensuring access to naloxone when supplies cannot be handed out. Unique challenges for pregnant and post-partum patients with substance use disorders includes some evidence of reduced access to medication to treat opioid use disorders and changes in delivery protocols that isolate birthing people from supports. Opportunities for all patients with substance use disorders include virtual platforms presenting positive opportunities for treatment. They are time efficient, eliminate transportation barriers, and potentially reduce childcare barriers. For pregnant and post-partum patients with substance use disorders, hybrid models of telemedicine and in-person visits reduced no-show visit rates and increased flexibility in medication dosing regimens. Thus, there is a unique opportunity to study the success of different virtual care models given the variety of implemented strategies. The COVID-19 pandemic provides an unprecedented opportunity to dramatically transform standard care approaches to help optimize care for all patients, including pregnant and post-partum people.