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Tele-transitions of care (TTOC): a 12-month, randomized controlled trial evaluating the use of Telehealth to achieve triple aim objectives.

ABSTRACT: BACKGROUND:Poor transitions of care leads to increased health costs, over-utilization of emergency room departments, increased re-hospitalizations and causes poor patient experiences and outcomes. This study evaluated Telehealth feasibility in improving transitions of care. METHODS:This is a 12-month randomized controlled trial, evaluating the use of telehealth (remote patient monitoring and video visits) versus standard transitions of care with the primary outcomes of hospital readmission and emergency department utilization and secondary outcomes of access to care, medication management and adherence and patient engagement. Electronic Medical Record data, Health Information Exchange data and phone survey data was collected. Multi-variable logistic regression models were created to evaluate the effect of Telehealth on hospital readmission, emergency department utilization, medication adherence. Chi-square tests or Fisher's exact tests were used to compare the percentages of categorical variables between the Telehealth and control groups. T tests or Wilcoxon rank sum tests were used to compared means and medians between the two randomized groups. RESULTS:The study conducted between June 2017 and 2018, included 102 patients. Compared with the standard of care, Telehealth patients were more likely to have medicine reconciliation (p?=?0.013) and were 7 times more likely to adhere to medication than the control group (p?=?0.03). Telehealth patients exhibited enthusiasm (p?=?0.0001), and confidence that Telehealth could improve their healthcare (p?=?0.0001). Telehealth showed no statistical significance on emergency department utilization (p?=?0.691) nor for readmissions (p?=?0.31). 100% of Telehealth patients found the intervention to be valuable, 98% if given the opportunity, reported they would continue using telehealth to manage their healthcare needs, and 94% reported that the remote patient monitoring technology was useful. CONCLUSIONS:Telehealth can improve transitions of care after hospital discharge improving patient engagement and adherence to medications. Although this study was unable to show the effect of Telehealth on reduced healthcare utilization, more research needs to be done in order to understand the true impact of Telehealth on preventing avoidable hospital readmission and emergency department visits. TRIAL REGISTRATION:ClinicalTrials.Gov ID: NCT03528850 Date Registered (Retrospective): 5/18/2018. Status: Completed. IRB #: 970227.

SUBMITTER: Noel K

PROVIDER: S-EPMC7007639 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Tele-transitions of care (TTOC): a 12-month, randomized controlled trial evaluating the use of Telehealth to achieve triple aim objectives.

Noel Kimberly K Messina Catherine C Hou Wei W Schoenfeld Elinor E Kelly Gerald G

BMC family practice 20200207 1

<h4>Background</h4>Poor transitions of care leads to increased health costs, over-utilization of emergency room departments, increased re-hospitalizations and causes poor patient experiences and outcomes. This study evaluated Telehealth feasibility in improving transitions of care.<h4>Methods</h4>This is a 12-month randomized controlled trial, evaluating the use of telehealth (remote patient monitoring and video visits) versus standard transitions of care with the primary outcomes of hospital re ...[more]

PMID: 32033535

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Project description:BackgroundHuman connection is at the heart of medical care, but questions remain as to the effectiveness of interpersonal interventions. The purpose of this review was to characterize the associations between patient-provider interpersonal interventions and the quadruple aim outcomes (population health, patient experience, cost, and provider experience).MethodsWe sourced data from PubMed, EMBASE, and PsycInfo (January 1997-August 2017). Selected studies included randomized controlled trials and controlled observational studies that examined the association between patient-provider interpersonal interventions and at least one outcome measure of the quadruple aim. Two abstractors independently extracted information about study design, methods, and quality. We characterized evidence related to the objective of the intervention, type and duration of intervention training, target recipient (provider-only vs. provider-patient dyad), and quadruple aim outcomes.ResultsSeventy-three out of 21,835 studies met the design and outcome inclusion criteria. The methodological quality of research was moderate to high for most included studies; 67% of interventions targeted the provider. Most studies measured impact on patient experience; improvements in experience (e.g., satisfaction, patient-centeredness, reduced unmet needs) often corresponded with a positive impact on other patient health outcomes (e.g., quality of life, depression, adherence). Enhanced interpersonal interactions improved provider well-being, burnout, stress, and confidence in communicating with difficult patients. Roughly a quarter of studies evaluated cost, but the majority reported no significant differences between intervention and control groups. Among studies that measured time in the clinical encounter, intervention effects varied. Interventions with lower demands on provider time and effort were often as effective as those with higher demands.DiscussionSimple, low-demand patient-provider interpersonal interventions may have the potential to improve patient health and patient and provider experience, but there is limited evidence that these interventions influence cost-related outcomes.

Project description:Communication of science through online media has become a primary means of disseminating and connecting science with a public audience. However, online media can come in many forms and stories of scientific discovery can be told by many individuals. We tested whether the relationship of a spokesperson to the science story being told (i.e., the narrative perspective) influences how people react and respond to online science media. We created five video stimuli that fell into three treatments: a scientist presenting their own research (male or female), a third-party summarizing research (male or female), and an infographic-like video with no on-screen presenter. Each of these videos presented the same fabricated science story about the discovery of a new ant species (Formicidae). We used Qualtrics to administer and obtain survey responses from 515 participants (~100 per video). Participants were randomly assigned to one of the videos and after viewing the stimulus answered questions assessing their perceptions of the video (trustworthiness and enjoyment), the spokesperson (trustworthiness and competence), scientists in general (competence and warmth), and attitudes towards the research topic and funding. Participants were also asked to recall what they had seen and heard. We determined that when participants watched a video in which a scientist presented their own research, participants perceived the spokesperson as having more expertise than a third-party presenter, and as more trustworthy and having more expertise than the no-spokesperson stimuli. Viewing a scientist presenting their own work also humanized the research, with participants more often including a person in their answer to the recall question. Overall, manipulating the narrative perspective of the source of a single online video communication effort is effective at impacting immediate objective outcomes related to spokesperson perceptions, but whether those objectives can positively influence long-term goals requires more investigation.

Project description:ObjectivesTelehealth use has surged since the onset of the coronavirus disease 2019 (COVID-19) pandemic, but the evaluation of telehealth outcomes and performance has not necessarily matched the pace of its uptake. In this article we aim to guide the design of a telehealth evaluation system encompassing all four domains of the outcome measurement framework developed by the National Quality Forum (NQF) - access to care, cost, experience, and effectiveness. We aim to achieve this through proposing survey items that can be distributed to patients or clinicians as a questionnaire and providing suggestions on areas of focus for evaluation studies.MethodsUsing PubMed and Google Scholar search engines, we performed a literature review of articles related to the evaluation of telehealth outcomes that were published in English since 2000.ResultsWe found existing survey tools to assist the development of an evaluation questionnaire, and categorized items into the four NQF outcome domains. For each outcome domain, we also summarize existing work on evaluation and make recommendations on areas for future assessment. In particular, we found that telehealth accessibility and accommodations have been historically under-studied and provide tools to address this.ConclusionsEvaluating telehealth outcomes is critical to ensure efficient and high-quality care delivery, and we believe establishing an evaluation system will help practices assess and improve their telehealth systems as well as their ability to use telehealth to respond to the diverse needs of patients.Public interest summarySince the start of the coronavirus disease 2019 (COVID-19) pandemic, telehealth use has been on the rise. Evaluating outcomes related to telehealth is critically important, but given the urgency of telehealth uptake, many health systems and practices may not yet have evaluation systems in place. This article guides the design of a telehealth evaluation system by proposing several validated and novel survey questions that can be used as part of a patient or clinician questionnaire and suggesting important measures of outcome for evaluation studies to assess across the four domains of telehealth quality as outlined by the National Quality Forum (NQF) - access to care, cost, experience, and effectiveness. We present tools to reach priority populations who often lack access to remote care, including older adults, underrepresented minorities, and people with disabilities.

Dataset Information

Tele-transitions of care (TTOC): a 12-month, randomized controlled trial evaluating the use of Telehealth to achieve triple aim objectives.

Publications

Tele-transitions of care (TTOC): a 12-month, randomized controlled trial evaluating the use of Telehealth to achieve triple aim objectives.

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