IntroductionComprehensive transitions of care, reduce dangerous hospital readmissions. Telehealth offers promise, however few guidelines aid clinicians in introducing it in a feasible way while addressing the needs of a multi-comorbid population. Physician adoptability remains a significant barrier to the use of Telehealth due to data overload, concerns for disruptive workflows and uncertain practices. The methods proposed aid clinicians in implementing Telehealth training and research with limited resources to reach patients who need clinical surveillance most. This study introduces a new workflow for addressing tele-transitions of care, using risk stratification, remote patient monitoring, and patient-centered virtual visits. We propose a new communication tool which facilitates adoption. We take a clinically meaningful approach in assessing avoidable hospital readmissions, which can lead to further quality improvements and improved patient care.MethodsThis study design is a parallel-group, superiority, randomized controlled trial in which 180 patients are enrolled in the standard of care or Telehealth arms and evaluated for 30-days post hospitalization. The Telehealth group receives daily vitals surveillance with a "teledoc", a senior resident physician, who performs weekly virtual visits. The endpoint is 30-day hospital readmission. Patient data is collected on hospital utilization, patient self-management, physician and patient experience.DiscussionOur protocol introduces a novel study design with existing clinical trainees, to provide comprehensive tele-transitions of care to reduce avoidable readmissions.
Fewer than 50% of current training institutions are interested in or have the capacity for expansion of core residencies. The interest in establishing or expanding primary care is especially problematic. Because 70% of internal medicine residents become subspecialists, additional funds for GME at current rates would largely encourage the training of additional hospital-based and hospital-intensive specialists, with little impact on those who would practice adult primary care medicine. Significantly increasing the physician training for adult primary care medicine will require more substantial institutional incentives.
Introduction: Avoidable hospital readmissions and medical errors are costly and dangerous. Many hospital systems have invested in various transitions of care models, health information systems and now increasingly, in telehealth, to help improve care after hospitalization. Although many models and strategies exist to improve care transitions, very few guidelines address the role of health technology, data analytics and health information exchanges within this process. Few studies have described an optimal workflow for physicians performing virtual clinical surveillance using telehealth. Furthermore, although many published studies have conducted telehealth transition of care interventions for patients with specific disease pathologies, few studies evaluate interventions using multi-modal remote patient monitoring for patients with mixed-chronic conditions. This appears to be an ideal target audience for telehealth interventions given that, the factors affecting patient risks for readmission are often complex and multifactorial. Our study aims to evaluate a new workflow for addressing comprehensive transition of care, using risk stratification, telehealth remote patient monitoring, and patient-centered virtual visits. We also introduce a new communication tool for relaying tele-communication. Aim: To describe current study protocol and demonstrate the steps and stakeholders involved to ensure proper integration and scalability to other practices.
Purpose: The demand for physicians in the U.S., especially those practicing adult primary care, is accelerating and will inevitably require the expansion of residencies, despite current constraints on funding for graduate medical education (GME). A previous study showed little interest in or capacity for expansion of primary care residencies in current teaching hospitals in NYS. This study examines the interest in and capacity for establishing new programs among current non-teaching hospitals in that state. Design and Methods: Chief Executive Officers of eligible non-teaching hospitals in NYS were surveyed and asked if they had interest in establishing a residency program, what medical specialties they would choose assuming availability of additional funds, and what barriers there were to residency development. Results: Fourteen of 46 (30%) NYS sites completed the survey. All but one was interested in establishing residencies; 85 percent would establish new programs in Emergency Medicine; 76 percent in Family Medicine; and 54 percent in Internal Medicine and/or Primary Care Internal Medicine. Virtually all cited significant concerns related to funding, faculty supply, and need for medical school affiliations. Conclusions: A minimum of 28 percent of non-teaching hospitals in NYS have a significant interest in establishing a GME program. If implemented this could increase training in Family Medicine by 40 percent and Internal Medicine by 11 percent. However, there are formidable financial and structural barriers to doing so. Enhanced support programs that go beyond lifting of the current GME cap will be necessary to increase the training of primary care physicians.
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