Implementing a Telehospitalist Program Between Veterans Health Administration Hospitals: Outcomes, Acceptance, and Barriers to Implementation

Gutiérrez, Jeydith; Moeckli, Jane; Holcombe, Andrea; O'Shea, Amy; Bailey, George C.; Rewerts, Kelby; Hagiwara, Mariko; Sullivan, Steven A.; Simon, Melissa A.; Kaboli, Peter J.

doi:10.12788/jhm.3570

Cited by 10 publications

(23 citation statements)

References 30 publications

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“…One study evaluated satisfaction among 114 patients with a telehospitalist program with 91% reporting they were satisfied and 78% believed telehealth improved quality 29 . In another study, 85% of patients said they will recommend telemedicine even though some still preferred in‐person care: “If a doctor wasn't available, telemedicine is better than nothing.” 23 Patient satisfaction was reported as high by Gujral (data not shown) 27 and overall satisfaction measured by standard inpatient satisfaction surveys remained unchanged in two studies 20,26 Economic analysis: Four studies conducted formal cost‐analysis of telehospitalist programs with impact varying depending on telehealth services provided.…”

Section: Resultsmentioning

confidence: 99%

“…Some studies reported other process and utilization metrics including number of consultations 34,35 and efficiency or timing metrics 27,35,36 . with most showing no differences or improvement. Satisfaction and acceptance from patients, providers, or both was reported in nine studies 12,20,23,27,29,31,34–36 . Most showed that providers and staff had a high rate of satisfaction and felt that telehospitalists followed standards of care with some reporting improved patient care 12,23,27,29 .…”

Section: Resultsmentioning

confidence: 99%

“…Qualitative evaluations provided additional insight into the value perceived by care teams on telemedicine programs. One study quoted critical access hospital staff: “Our eyes were opened to how much patient care could be enhanced by this project” 12 and “I prefer a telehospitalist that really [cares] about patients than some provider that is physically here but does not engage.” 20 Informal staff interviews reported by Zachariah 34 showed that telemedicine supported staff motivation and they felt they were not “working in isolation.” Technology issues were reported by several studies as an adoption barrier. One study evaluated satisfaction among 114 patients with a telehospitalist program with 91% reporting they were satisfied and 78% believed telehealth improved quality 29 .…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of telehealth applications in hospital medicine

Gutiérrez

Rewerts

CarlLee

et al. 2022

Journal of Hospital Medicine

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Background: Despite the proliferation of telehealth, uptake for acute inpatient services has been slower. Hospitalist shortages in rural and critical access hospitals as well as the COVID-19 pandemic have led to a renewed interest in telehealth to deliver acute inpatient services. Understanding current evidence is crucial for promoting uptake and developing evidence-based practices.Objective: To conduct a systematic review of telehealth applications in acute inpatient general medicine and pediatric hospital wards and synthesize available evidence. Data Sources: A search of five databases (PubMed, CINAHL, Embase, Scopus, and ProQuest Theses, and Dissertations) using a combination of search terms including telemedicine and hospital medicine/inpatient care keywords yielded 17,015 citations. Study Selection and Data Extraction: Two independent coders determined eligibility based on inclusion and exclusion criteria. Data were extracted and organized into main categories based on findings: (1) feasibility and planning, (2) implementation and technology, and (3) telehealth application process and outcome measures. Results: Of the 20 publications included, three were feasibility and planning studies describing the creation of the program, services provided, and potential cost implications. Five studies described implementation and technology used, including training, education, and evaluation methods. Finally, twelve discussed process and outcome measures, including patient and provider satisfaction and costs. Conclusion:Telehealth services for hospital medicine were found to be effective, well received, and initial cost estimates appear favorable. A variety of services were described across programs with considerable benefit appreciated by rural and smaller hospitals.Additional work is needed to evaluate clinical outcomes and overall program costs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A systematic review of telehealth applications in hospital medicine

Gutiérrez

Rewerts

CarlLee

et al. 2022

Journal of Hospital Medicine

Self Cite

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“…The program has four years of telemedicine experience with various programs. 17 , 18 The Influenza-Like Illness (ILI) Clinic is an outpatient clinic, staffed by over 40 primary care physicians and APPs, that utilizes in-person and telemedicine visits to diagnose and treat acute respiratory illnesses. The HMP was a combined initiative between the Adult Hospitalist Program and the ILI clinic in response to the COVID-19 pandemic.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of a home telemonitoring program for SARS-CoV-2 viral infection at a large academic medical center

et al. 2022

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Introduction Telemedicine serves as a viable option during the COVID-19 pandemic to provide in-home care, maintain home isolation precautions, reduce unnecessary healthcare exposures, and de-burden hospitals. Methods We created a novel telemedicine program to closely monitor patients infected with SARS-CoV-2 (COVID-19) at home. Adult patients with COVID-19 were enrolled in the program at the time of documented infection. Patients were followed by a team of providers via telephone or video visits at frequent intervals until resolution of their acute illness. Additionally, patients were stratified into high-risk and low-risk categories based on demographics and underlying comorbidities. The primary outcome was hospitalization after enrollment in the home monitoring program, including 30 days after discharge from the program. Results Over a 3.5-month period, 1128 patients met criteria for enrollment in the home monitoring program. 30.7% were risk stratified as high risk for poor outcomes based on their comorbidities and age. Of the 1128 patients, 6.2% required hospitalization and 1.2% required ICU admission during the outcome period. Hospitalization was more frequent in patients identified as high risk (14.2% vs 2.7%, P < 0.001). Discussion Enrollment in a home monitoring program appears to be an effective and sustainable modality for the ambulatory management of COVID-19.

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“…In this issue of the Journal of Hospital Medicine , Gutierrez and colleagues 1 evaluate the implementation and outcomes of a rural telehospitalist program. In a hub‐and‐spoke fashion, providers at a large tertiary care hospital utilized telemedicine to round on patients with an onsite advanced practice provider at a 10‐bed critical access hospital.…”

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confidence: 99%