Date of Award

Spring 6-1-2021

Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Faculty Chair

Terra Mangum

Faculty Reader

Marie Holt

Executive Summary

Background and Significance

The COVID-19 pandemic necessitated the use and rapid adoption of telemedicine throughout 2020, with a 2980% rise in telehealth claims from September 2019 to September 2020, as Americans were encouraged to stay home to limit the spread of the novel coronavirus (Gelburd, 2020). Though many restrictions related to COVID-19 have been lifted, telemedicine utilization remains 38 times higher than it was pre-pandemic (Bestennnyy et al., 2021). Prior to the pandemic, limited research existed regarding how telemedicine was implemented in health systems, how patients were experiencing care virtually, and how satisfied they were with the care delivered through telemedicine. This project, completed at a large urban health system, examines the rapid utilization and impact of virtual care on patients’ experiences and satisfaction with virtual care.

Problem and Purpose Statement

Americans in both urban and rural areas faced limited access to in-person care during the COVID-19 pandemic, as patients and providers were encouraged to stay home to help limit the transmission of the virus, to "flatten the infection curve" (Leite et. al., 2020). Limited access to in-person care sparked concerns regarding disease management for patients with chronic diseases. Patients and providers held reservations regarding long term implementation of telemedicine beyond the pandemic, with concerns primarily in the quality of care that is delivered virtually. The purpose of this project was to understand the utilization of telemedicine among various medical specialties throughout the COVID-19 pandemic, and in doing so, understand the patient experience and satisfaction with virtual care.

Methods

The project was designed as a program evaluation of widespread telemedicine implementation throughout the clinics of a major metropolitan health system. A descriptive analysis was conducted of patient satisfaction reports across medical specialties for patients receiving care at the healthcare system and associated clinics. Trends were compared in the data reports from the start of the COVID-19 pandemic and throughout 2020, with widespread use of virtual care as ability to attend in-person visits was limited. All patient satisfaction reports regarding telemedicine experience were included (4/1/2020-12/31/2020) for patients receiving care at the health system and associated clinics. Patient satisfaction measures were collected through de-identified data reports of patient satisfaction collected by the healthcare organization via survey. The survey data included information specific to patients’ experiences with the telemedicine practice change.

Results / Outcomes

Utilization of telemedicine seems to have grown across services in 2020, peaking in Q3, and declining in use in Q4. Services that led the widespread implementation of telemedicine were internal medicine (2,241) and family practice (936). Across services, mean patient satisfaction with audio connection, video connection and telemedicine technology overall were high, above 85% in each category. Mean satisfaction scores increased across services in each category, representing that the technology may have become more dependable throughout the year as patients and providers became more comfortable with virtual care, or that users became increasingly knowledgeable about how to navigate online portals and communication channels. Responses were mixed across services for rating the ease of talking with care provider over video, with highest satisfaction in pharmacy (95%), dermatology (94%), hematology/oncology (94%), physical orthopedics (93%) and infectious disease (93%). Nearly half of the services saw improvement in mean satisfaction for ease of talking to care provider, but some saw significant decline. The services that saw decline include neurophysiology (25% reduction in mean patient satisfaction), allergy/immunology (16% reduction in mean patient satisfaction) and neurosurgery (12% reduction in mean patient satisfaction). These declines may reveal that telemedicine was not an effective way to deliver care in these services.

Sustainability

The results from this project may provide new insight into patient experiences with telemedicine and the satisfaction they have with the widespread implementation of virtual care. The findings reveal which services have highest utilization of telemedicine, which services have highest satisfaction in talking with care providers virtually, and highest satisfaction with telemedicine overall. Appropriate further evaluation of virtual care within this health system includes patients’ clinical outcomes with telemedicine and a more detailed questionnaire regarding their experiences with virtual care.

Implications for Practice

This project may influence patient care delivery for years to come as telemedicine is implemented and invested in across medical specialties within the associated health system. Early in the COVID-19 pandemic, patients and providers alike vocalized concerns of the impact of virtual care on quality of care. The analysis from this project reveals that most services had high rates of satisfaction with connecting with their providers over video. In the future, patients, providers, and hospital leadership may be able to refer to this data and other sets like it to determine which populations and services may benefit most from the implementation of virtual care. This may increase confidence in virtual care implementation among patients in the services that have shown satisfaction with its use.


References

Bestennnyy, O., Gilbert, G., Harris, A., & Rost, J. (2021). Telehealth: A quarter-trillion-dollar post-COVID-19 reality? McKinsey & Company.

Gelburd, R. (2020). Telehealth Claim Lines Rise 2980% in One-Year Period Through September 2020. American Journal of Managed Care.

Leite, H., Hodgkinson, I. & Gruber, T. (2020, April 09). New development: ‘Healing at a distance’—telemedicine and COVID-19. Public Money & Management. https://doi.org/10.1080/09540962.2020.1748855

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