Innovative virtual care delivery in a Canadian paediatric tertiary-care centre

Goldbloom, Ellen B; Buba, Melanie; Bhatt, Maala; Suntharalingam, Sinthuja; King, W. James

doi:10.1093/pch/pxab104

Cited by 13 publications

(10 citation statements)

References 23 publications

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“…Virtual care delivery models are increasingly embraced, particularly in the post-COVID era, 29 with ECAs increasingly being used in health care. 15 Our study extends existing knowledge by evaluating the effect of a child-friendly ECA during appointment waiting times to reduce requests for specialist appointments.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of a Web-Based Management Support System for Children With Urinary Incontinence: The eADVICE Trial

Caldwell,

Richards,

Hamilton

et al. 2024

Journal of Urology

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Purpose:Children referred to specialist outpatient clinics by primary care providers often have long waiting times before being seen. We assessed whether an individualized, web-based, evidence-informed management support for children with urinary incontinence while waiting reduced requests for specialist appointments.Materials and Methods:A multicenter, waitlisted randomized controlled trial was conducted for children (5-18 years) with urinary incontinence referred to tertiary pediatric continence clinics. Participants were randomized to the web-based eHealth program electronic Advice and Diagnosis Via the Internet following Computerized Evaluation (eADVICE), which used an embodied conversational agent to engage with the child at the time of referral (intervention) or 6 months later (control). The primary outcome was the proportion of participants requesting a clinic appointment at 6 months. Secondary outcomes included persistent incontinence, and the Paediatric incontinence Questionnaire (PinQ) score.Results:From 2018 to 2020, 239 children enrolled, with 120 randomized to eADVICE and 119 to the control arm. At baseline, participants’ mean age was 8.8 years (SD 2.2), 62% were males, mean PinQ score was 5.3 (SD 2.2), 36% had daytime incontinence, and 97% had nocturnal enuresis. At 6 months, 78% of eADVICE participants vs 84% of controls requested a clinic visit (relative risk 0.92, 95% CI 0.79, 1.06, P = .3), and 23% eADVICE participants vs 10% controls were completely dry (relative risk 2.23, 95% CI 1.10, 4.50, P = .03). The adjusted mean PinQ score was 3.5 for eADVICE and 3.9 for controls (MD −0.37, 95% CI −0.71, −0.03, P = .03).Conclusions:The eADVICE eHealth program for children awaiting specialist appointments doubled the proportion who were dry at 6 months and improved quality of life but did not reduce clinic appointment requests.

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Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of a Web-Based Management Support System for Children With Urinary Incontinence: The eADVICE Trial

Caldwell,

Richards,

Hamilton

et al. 2024

Journal of Urology

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“…For example, we now deliver approximately 40% of annual outpatient visits virtually, 25 with program-level virtual care evaluation projects, and separate centre-wide initiatives to collect feedback from patients, families, and healthcare providers. 24 However, a comprehensive evaluation approach has not been standardized across the organization. Thus, we formed a multidisciplinary working group of virtual care leaders and stakeholders to develop a uni ed approach to virtual care evaluation.…”

Section: Setting and Teammentioning

confidence: 99%

The evolution of a pediatric virtual care evaluation framework

Dulude

Sutherland

Vanderhout

et al. 2022

Preprint

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Background The use of virtual care has increased dramatically in response to the COVID-19 pandemic, yet evidence is lacking regarding the impact of virtual care on patient outcomes, particularly in pediatrics. A standardized evaluation approach is required to support the integration of virtual care into pediatric health care delivery programs. The objective of this work was to develop a comprehensive and structured framework for pediatric virtual care evaluation. This framework is intended to engage and guide care providers, health centres, and stakeholders towards the development of a standardized approach to the evaluation of pediatric virtual care. Methods We brought together a diverse multidisciplinary team, including pediatric clinicians, researchers, digital health leads and analysts, program leaders, a human factors engineer, a family advisor and our manager of health equity and diversity. The team reviewed the literature, including published evaluation frameworks, and used a consensus-based method to develop a virtual care evaluation framework applicable to a broad spectrum of pediatric virtual care programs. We iteratively developed framework components including domains and sub-domains, examples of evaluation questions, measures, and data sources. Team members provided feedback on all components of the framework until consensus was reached. The framework was then applied to an existing virtual care program. Results The resulting framework includes four domains (health outcomes, health delivery, individual experience, and program implementation) and 19 sub-domains designed to support the development and evaluation of pediatric virtual care programs. We also developed guidance on how to use the framework and illustrate its utility by applying it to an existing pediatric virtual care program. Conclusions This virtual care evaluation framework expands on previously developed frameworks by providing additional detail and a structure that supports practical application. It can be used to evaluate a wide range of pediatric virtual care programs in a standardized manner. Use of this comprehensive yet easy to use evaluation framework will inform appropriate implementation and integration of virtual care into routine practice and support its sustainability and continuous improvement.

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“…The tablets were set on a rolling table with hospital grade cleaning wipes (Oxivir Tb Disinfectant Wipes). 13,14 Patient handover for physician teams occurred at 0730. Patients were assigned to medical trainees and seen in-person prior to rounds, if possible.…”

Section: Approachmentioning

confidence: 99%

“…At the end of vFCR the tablets were returned to the unit clerk for charging and safe storage. 13,14 Studying Virtual Family-Centered Rounds This project took place from April 6 to July 31, 2020. During this period the average patient census was 11 patients per team (SD=3.7).…”

Section: Approachmentioning

confidence: 99%

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Virtual family-centered rounds: Adapting inpatient care during COVID-19

Buba

Dulude

O’Donnell

et al. 2022

Preprint

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Background: Family-centered rounds (FCR) are fundamental to pediatric inpatient care. During the COVID-19 pandemic, we aimed to design and implement a virtual family-centered rounds (vFCR) process that allowed continuation of inpatient rounds while following physical distancing guidelines and preserving personal protective equipment (PPE). Methods: A multidisciplinary team developed the vFCR process using a participatory design approach. From April through July 2020, quality improvement methods were used to iteratively evaluate and improve the process. Outcome measures included satisfaction, perceived effectiveness, and perceived usefulness of vFCR. Data were collected via questionnaire distributed to patients, families, staff and medical staff, and analyzed using descriptive statistics and content analysis. Virtual auditors monitored time per patient round and transition time between patients as balancing measures. Results: Seventy-four percent (51/69) of health care providers surveyed and 79% (26/33) of patients and families were satisfied or very satisfied with vFCR. Eighty eight percent (61/69) of health care providers and 88% (29/33) of patients and families felt vFCR were useful. Audits revealed an average vFCR duration of 8.4 min (SD=3.9) for a single patient round and transition time between patients averaged 2.9 min (SD=2.6). Conclusion: Virtual family-centered rounds are an acceptable alternative to in-person FCR in a pandemic scenario, yielding high levels of stakeholder satisfaction and support. We believe vFCR are a useful method to support inpatient rounds, physical distancing, and preservation of PPE that may also be valuable beyond the pandemic. A rigorous process evaluation of vFCR is underway.

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Innovative virtual care delivery in a Canadian paediatric tertiary-care centre

Cited by 13 publications

References 23 publications

A Randomized Controlled Trial of a Web-Based Management Support System for Children With Urinary Incontinence: The eADVICE Trial

A Randomized Controlled Trial of a Web-Based Management Support System for Children With Urinary Incontinence: The eADVICE Trial

The evolution of a pediatric virtual care evaluation framework

Virtual family-centered rounds: Adapting inpatient care during COVID-19

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