CovidStanfordV1, Main, Exploration, bibRecord, 000354

Qualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical Center.

Identifieur interne : 000354 ( Main/Exploration ); précédent : 000353; suivant : 000355

Qualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical Center.

Auteurs : Malathi Srinivasan ; Steven Asch ; Stacie Vilendrer ; Samuel Crandall Thomas ; Rika Bajra ; Linda Barman ; Lauren Michelle Edwards ; Heather Filipowicz ; Lena Giang ; Olivia Jee ; Megan Mahoney ; Ian Nelligan ; Anuradha Jayant Phadke ; Elise Torres ; Maja Artandi

Source :

Annals of internal medicine [ 1539-3704 ] ; 2020.

RBID : pubmed:32628536

Descripteurs français

KwdFr :
- Adulte (MeSH), Attitude du personnel soignant (MeSH), Betacoronavirus (MeSH), Californie (épidémiologie), Femelle (MeSH), Humains (MeSH), Infections à coronavirus (épidémiologie), Mâle (MeSH), Pandémies (MeSH), Pneumopathie virale (épidémiologie), Recherche qualitative (MeSH), Soins de santé primaires (méthodes), Télémédecine (méthodes).
MESH :
- méthodes : Soins de santé primaires, Télémédecine.
- épidémiologie : Californie, Infections à coronavirus, Pneumopathie virale.
- Adulte, Attitude du personnel soignant, Betacoronavirus, Femelle, Humains, Mâle, Pandémies, Recherche qualitative.

English descriptors

KwdEn :
- Adult (MeSH), Attitude of Health Personnel (MeSH), Betacoronavirus (MeSH), COVID-19 (MeSH), California (epidemiology), Coronavirus Infections (epidemiology), Female (MeSH), Humans (MeSH), Male (MeSH), Pandemics (MeSH), Pneumonia, Viral (epidemiology), Primary Health Care (methods), Qualitative Research (MeSH), SARS-CoV-2 (MeSH), Telemedicine (methods).
MESH :
- geographic , epidemiology : California.
- epidemiology : Coronavirus Infections, Pneumonia, Viral.
- methods : Primary Health Care, Telemedicine.
- Adult, Attitude of Health Personnel, Betacoronavirus, COVID-19, Female, Humans, Male, Pandemics, Qualitative Research, SARS-CoV-2.

Abstract

BACKGROUND

The coronavirus disease 2019 pandemic spurred health systems across the world to quickly shift from in-person visits to safer video visits.

OBJECTIVE

To seek stakeholder perspectives on video visits' acceptability and effect 3 weeks after near-total transition to video visits.

DESIGN

Semistructured qualitative interviews.

SETTING

6 Stanford general primary care and express care clinics at 6 northern California sites, with 81 providers, 123 staff, and 97 614 patient visits in 2019.

PARTICIPANTS

53 program participants (overlapping roles as medical providers [

INTERVENTION

In 3 weeks, express care and primary care video visits increased from less than 10% to greater than 80% and from less than 10% to greater than 75%, respectively. New video visit providers received video visit training and care quality feedback. New system workflows were created to accommodate the new visit method.

MEASUREMENTS

9 faculty, trained in qualitative research methods, conducted 53 stakeholder interviews in 4 days using purposeful (administrators and technologists) and convenience (medical assistant, nurses, and providers) sampling. A rapid qualitative analytic approach for thematic analysis was used.

RESULTS

The analysis revealed 12 themes, including Pandemic as Catalyst; Joy in Medicine; Safety in Medicine; Slipping Through the Cracks; My Role, Redefined; and The New Normal. Themes were analyzed using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to identify critical issues for continued program utilization.

LIMITATIONS

Evaluation was done immediately after deployment. Although viewpoints may have evolved later, immediate evaluation allowed for prompt program changes and identified broader issues to address for program sustainability.

CONCLUSION

After pandemic-related systems transformation at Stanford, critical issues to sustain video visit long-term viability were identified. Specifically, technology ease of use must improve and support multiparty videoconferencing. Providers should be able to care for their patients, regardless of geography. Providers need decision-making support with virtual examination training and home-based patient diagnostics. Finally, ongoing video visit reimbursement should be commensurate with value to the patients' health and well-being.

PRIMARY FUNDING SOURCE

Stanford Department of Medicine and Stanford Health Care.

DOI: 10.7326/M20-1814
PubMed: 32628536
PubMed Central: PMC7370832

Affiliations:

Links toward previous steps (curation, corpus...)

to stream Main, to step Corpus: 000536
to stream Main, to step Curation: 000536

Le document en format XML

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<author><name sortKey="Torres, Elise" sort="Torres, Elise" uniqKey="Torres E" first="Elise" last="Torres">Elise Torres</name>
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<wicri:noCountry code="subField">California (R.B.).</wicri:noCountry>
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<wicri:noCountry code="subField">O.J.).</wicri:noCountry>
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<author><name sortKey="Mahoney, Megan" sort="Mahoney, Megan" uniqKey="Mahoney M" first="Megan" last="Mahoney">Megan Mahoney</name>
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<wicri:noCountry code="subField">M.A.).</wicri:noCountry>
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<author><name sortKey="Nelligan, Ian" sort="Nelligan, Ian" uniqKey="Nelligan I" first="Ian" last="Nelligan">Ian Nelligan</name>
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<wicri:noCountry code="subField">M.A.).</wicri:noCountry>
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<author><name sortKey="Phadke, Anuradha Jayant" sort="Phadke, Anuradha Jayant" uniqKey="Phadke A" first="Anuradha Jayant" last="Phadke">Anuradha Jayant Phadke</name>
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<wicri:noCountry code="subField">M.A.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Torres, Elise" sort="Torres, Elise" uniqKey="Torres E" first="Elise" last="Torres">Elise Torres</name>
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<wicri:noCountry code="subField">California (E.T.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Artandi, Maja" sort="Artandi, Maja" uniqKey="Artandi M" first="Maja" last="Artandi">Maja Artandi</name>
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<wicri:noCountry code="subField">M.A.).</wicri:noCountry>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term>
<term>Attitude of Health Personnel (MeSH)</term>
<term>Betacoronavirus (MeSH)</term>
<term>COVID-19 (MeSH)</term>
<term>California (epidemiology)</term>
<term>Coronavirus Infections (epidemiology)</term>
<term>Female (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Male (MeSH)</term>
<term>Pandemics (MeSH)</term>
<term>Pneumonia, Viral (epidemiology)</term>
<term>Primary Health Care (methods)</term>
<term>Qualitative Research (MeSH)</term>
<term>SARS-CoV-2 (MeSH)</term>
<term>Telemedicine (methods)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term>
<term>Attitude du personnel soignant (MeSH)</term>
<term>Betacoronavirus (MeSH)</term>
<term>Californie (épidémiologie)</term>
<term>Femelle (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Infections à coronavirus (épidémiologie)</term>
<term>Mâle (MeSH)</term>
<term>Pandémies (MeSH)</term>
<term>Pneumopathie virale (épidémiologie)</term>
<term>Recherche qualitative (MeSH)</term>
<term>Soins de santé primaires (méthodes)</term>
<term>Télémédecine (méthodes)</term>
</keywords>
<keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>California</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Primary Health Care</term>
<term>Telemedicine</term>
</keywords>
<keywords scheme="MESH" qualifier="méthodes" xml:lang="fr"><term>Soins de santé primaires</term>
<term>Télémédecine</term>
</keywords>
<keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Californie</term>
<term>Infections à coronavirus</term>
<term>Pneumopathie virale</term>
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<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Attitude of Health Personnel</term>
<term>Betacoronavirus</term>
<term>COVID-19</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Pandemics</term>
<term>Qualitative Research</term>
<term>SARS-CoV-2</term>
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<term>Attitude du personnel soignant</term>
<term>Betacoronavirus</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mâle</term>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>The coronavirus disease 2019 pandemic spurred health systems across the world to quickly shift from in-person visits to safer video visits.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b>
</p>
<p>To seek stakeholder perspectives on video visits' acceptability and effect 3 weeks after near-total transition to video visits.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>DESIGN</b>
</p>
<p>Semistructured qualitative interviews.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>SETTING</b>
</p>
<p>6 Stanford general primary care and express care clinics at 6 northern California sites, with 81 providers, 123 staff, and 97 614 patient visits in 2019.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>PARTICIPANTS</b>
</p>
<p>53 program participants (overlapping roles as medical providers [</p>
</div>
<div type="abstract" xml:lang="en"><p><b>INTERVENTION</b>
</p>
<p>In 3 weeks, express care and primary care video visits increased from less than 10% to greater than 80% and from less than 10% to greater than 75%, respectively. New video visit providers received video visit training and care quality feedback. New system workflows were created to accommodate the new visit method.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>MEASUREMENTS</b>
</p>
<p>9 faculty, trained in qualitative research methods, conducted 53 stakeholder interviews in 4 days using purposeful (administrators and technologists) and convenience (medical assistant, nurses, and providers) sampling. A rapid qualitative analytic approach for thematic analysis was used.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>The analysis revealed 12 themes, including Pandemic as Catalyst; Joy in Medicine; Safety in Medicine; Slipping Through the Cracks; My Role, Redefined; and The New Normal. Themes were analyzed using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to identify critical issues for continued program utilization.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>LIMITATIONS</b>
</p>
<p>Evaluation was done immediately after deployment. Although viewpoints may have evolved later, immediate evaluation allowed for prompt program changes and identified broader issues to address for program sustainability.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSION</b>
</p>
<p>After pandemic-related systems transformation at Stanford, critical issues to sustain video visit long-term viability were identified. Specifically, technology ease of use must improve and support multiparty videoconferencing. Providers should be able to care for their patients, regardless of geography. Providers need decision-making support with virtual examination training and home-based patient diagnostics. Finally, ongoing video visit reimbursement should be commensurate with value to the patients' health and well-being.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>PRIMARY FUNDING SOURCE</b>
</p>
<p>Stanford Department of Medicine and Stanford Health Care.</p>
</div>
</front>
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<Abstract><AbstractText Label="BACKGROUND">The coronavirus disease 2019 pandemic spurred health systems across the world to quickly shift from in-person visits to safer video visits.</AbstractText>
<AbstractText Label="OBJECTIVE">To seek stakeholder perspectives on video visits' acceptability and effect 3 weeks after near-total transition to video visits.</AbstractText>
<AbstractText Label="DESIGN">Semistructured qualitative interviews.</AbstractText>
<AbstractText Label="SETTING">6 Stanford general primary care and express care clinics at 6 northern California sites, with 81 providers, 123 staff, and 97 614 patient visits in 2019.</AbstractText>
<AbstractText Label="PARTICIPANTS">53 program participants (overlapping roles as medical providers [<i>n</i>
 = 20], medical assistants [<i>n</i>
 = 16], nurses [<i>n</i>
 = 4], technologists [<i>n</i>
 = 4], and administrators [<i>n</i>
 = 13]) were interviewed about video visit transition and challenges.</AbstractText>
<AbstractText Label="INTERVENTION">In 3 weeks, express care and primary care video visits increased from less than 10% to greater than 80% and from less than 10% to greater than 75%, respectively. New video visit providers received video visit training and care quality feedback. New system workflows were created to accommodate the new visit method.</AbstractText>
<AbstractText Label="MEASUREMENTS">9 faculty, trained in qualitative research methods, conducted 53 stakeholder interviews in 4 days using purposeful (administrators and technologists) and convenience (medical assistant, nurses, and providers) sampling. A rapid qualitative analytic approach for thematic analysis was used.</AbstractText>
<AbstractText Label="RESULTS">The analysis revealed 12 themes, including Pandemic as Catalyst; Joy in Medicine; Safety in Medicine; Slipping Through the Cracks; My Role, Redefined; and The New Normal. Themes were analyzed using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to identify critical issues for continued program utilization.</AbstractText>
<AbstractText Label="LIMITATIONS">Evaluation was done immediately after deployment. Although viewpoints may have evolved later, immediate evaluation allowed for prompt program changes and identified broader issues to address for program sustainability.</AbstractText>
<AbstractText Label="CONCLUSION">After pandemic-related systems transformation at Stanford, critical issues to sustain video visit long-term viability were identified. Specifically, technology ease of use must improve and support multiparty videoconferencing. Providers should be able to care for their patients, regardless of geography. Providers need decision-making support with virtual examination training and home-based patient diagnostics. Finally, ongoing video visit reimbursement should be commensurate with value to the patients' health and well-being.</AbstractText>
<AbstractText Label="PRIMARY FUNDING SOURCE">Stanford Department of Medicine and Stanford Health Care.</AbstractText>
</Abstract>
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<ForeName>Malathi</ForeName>
<Initials>M</Initials>
<Identifier Source="ORCID">0000-0001-9951-0016</Identifier>
<AffiliationInfo><Affiliation>Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.).</Affiliation>
</AffiliationInfo>
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<ForeName>Steven</ForeName>
<Initials>S</Initials>
<Identifier Source="ORCID">0000-0001-5838-5335</Identifier>
<AffiliationInfo><Affiliation>Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.).</Affiliation>
</AffiliationInfo>
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<ForeName>Stacie</ForeName>
<Initials>S</Initials>
<Identifier Source="ORCID">0000-0003-2317-5973</Identifier>
<AffiliationInfo><Affiliation>Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.).</Affiliation>
</AffiliationInfo>
</Author>
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<ForeName>Samuel Crandall</ForeName>
<Initials>SC</Initials>
<Identifier Source="ORCID">0000-0001-9264-2358</Identifier>
<AffiliationInfo><Affiliation>Stanford University School of Medicine and Intermountain Delivery Institute, Intermountain Healthcare, Palo Alto, California (S.C.T.).</Affiliation>
</AffiliationInfo>
</Author>
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<ForeName>Rika</ForeName>
<Initials>R</Initials>
<Identifier Source="ORCID">0000-0002-1378-2561</Identifier>
<AffiliationInfo><Affiliation>Stanford University School of Medicine, Portola Valley, California (R.B.).</Affiliation>
</AffiliationInfo>
</Author>
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<ForeName>Linda</ForeName>
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<Initials>LM</Initials>
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<AffiliationInfo><Affiliation>Stanford University School of Medicine, Los Altos, California (L.M.E., O.J.).</Affiliation>
</AffiliationInfo>
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<ForeName>Heather</ForeName>
<Initials>H</Initials>
<Identifier Source="ORCID">0000-0003-1273-0820</Identifier>
<AffiliationInfo><Affiliation>Stanford Health Care, Palo Alto, California (H.F., L.G.).</Affiliation>
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<ForeName>Lena</ForeName>
<Initials>L</Initials>
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<ForeName>Olivia</ForeName>
<Initials>O</Initials>
<Identifier Source="ORCID">0000-0002-1255-7055</Identifier>
<AffiliationInfo><Affiliation>Stanford University School of Medicine, Los Altos, California (L.M.E., O.J.).</Affiliation>
</AffiliationInfo>
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<ForeName>Megan</ForeName>
<Initials>M</Initials>
<Identifier Source="ORCID">0000-0001-9166-9575</Identifier>
<AffiliationInfo><Affiliation>Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.).</Affiliation>
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<Initials>I</Initials>
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<ForeName>Anuradha Jayant</ForeName>
<Initials>AJ</Initials>
<Identifier Source="ORCID">0000-0002-9105-8667</Identifier>
<AffiliationInfo><Affiliation>Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.).</Affiliation>
</AffiliationInfo>
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<ForeName>Elise</ForeName>
<Initials>E</Initials>
<AffiliationInfo><Affiliation>Stanford University School of Medicine, Santa Clara, California (E.T.).</Affiliation>
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<Initials>M</Initials>
<AffiliationInfo><Affiliation>Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.).</Affiliation>
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<Language>eng</Language>
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<Month>07</Month>
<Day>06</Day>
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</MeshHeading>
<MeshHeading><DescriptorName UI="D002140" MajorTopicYN="N" Type="Geographic">California</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName>
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Qualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical Center.

Qualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical Center.

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