Regional Strategies for Academic Health Centers to Support Primary Care During the COVID-19 Pandemic: A Plea From the Front Lines

DeVoe, Jennifer E.; Cheng, Anthony; Krist, Alex H.

doi:10.1001/jamahealthforum.2020.0423

Cited by 16 publications

(10 citation statements)

References 2 publications

(3 reference statements)

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“…MEOC's original plan did not incorporate clinical trainees; however, during deescalation MEOC and Postgraduate Medical Education leaders formalized the inclusion of DOM residents in COVID-19 clinical services, thus expanding the skilled physician workforce. 23 To date, clinical clerks have been excluded from any COVID-19 clinical care. These examples demonstrate a flexible partnership between a health system and an academic institution, beyond those well established for education and clinical research.…”

Section: Key Implementation Insights From Meocmentioning

confidence: 99%

“…However, at its core, the Pod-based staffing model depended on volunteerism by non-acute care physicians with concurrent ambulatory care responsibilities, neglect of which could further increase acute care demand. The evolving understanding of neglected chronic disease care during a pandemic, 23 along with the transfer of workforce planning to DOM leadership, has enabled coordination of acute and ambulatory care strategies during the second wave.…”

Section: Key Implementation Insights From Meocmentioning

confidence: 99%

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Description of a Multi-faceted COVID-19 Pandemic Physician Workforce Plan at a Multi-site Academic Health System

et al. 2021

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Background The evolving COVID-19 pandemic has and continues to present a threat to health system capacity. Rapidly expanding an existing acute care physician workforce is critical to pandemic response planning in large urban academic health systems. Intervention The Medical Emergency-Pandemic Operations Command (MEOC)—a multi-specialty team of physicians, operational leaders, and support staff within an academic Department of Medicine in Calgary, Canada—partnered with its provincial health system to rapidly develop a comprehensive, scalable pandemic physician workforce plan for non-ventilated inpatients with COVID-19 across multiple hospitals. The MEOC Pandemic Plan comprised seven components, each with unique structure and processes. Methods In this manuscript, we describe MEOC’s Pandemic Plan that was designed and implemented from March to May 2020 and re-escalated in October 2020. We report on the plan’s structure and process, early implementation outcomes, and unforeseen challenges. Data sources included MEOC documents, health system, public health, and physician engagement implementation data. Key Results From March 5 to October 26, 2020, 427 patients were admitted to COVID-19 units in Calgary hospitals. In the initial implementation period (March–May 2020), MEOC communications reached over 2500 physicians, leading to 1446 physicians volunteering to provide care on COVID-19 units. Of these, 234 physicians signed up for hospital shifts, and 227 physicians received in-person personal protective equipment simulation training. Ninety-three physicians were deployed on COVID-19 units at four large acute care hospitals. The resurgence of cases in September 2020 has prompted re-escalation including re-activation of COVID-19 units. Conclusions MEOC leveraged an academic health system partnership to rapidly design, implement, and refine a comprehensive, scalable COVID-19 acute care physician workforce plan whose components are readily applicable across jurisdictions or healthcare crises. This description may guide other institutions responding to COVID-19 and future health emergencies.

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Section: Key Implementation Insights From Meocmentioning

confidence: 99%

Section: Key Implementation Insights From Meocmentioning

confidence: 99%

Description of a Multi-faceted COVID-19 Pandemic Physician Workforce Plan at a Multi-site Academic Health System

et al. 2021

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“…DeVoe and colleagues recently published a plea for a regional telehealth primary care extension infrastructure to address the demands being placed on care systems. [28] Our findings provide evidence for the effectiveness of such an approach, and suggest that policymakers and medical and public health leaders should consider widespread implementation of physician-staffed telehealth services as a key component of effective, equitable pandemic response.…”

Section: Discussionmentioning

confidence: 83%

On the Front (Phone) Lines: Results of a COVID-19 Hotline in Northeast Ohio

Margolius

Hennekes

Yao

et al. 2020

Preprint

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medRxiv preprint Key PointsQuestion: What is the feasibility and effectiveness of physician telehealth services during a pandemic?Findings: In this cohort study of a COVID-19 telehealth hotline that included 10,112 callers and 4,213 physician telehealth visits, most patients (79%) were advised to self-isolate at home, 14% were found unlikely to have COVID-19, 4% dispositions (e.g. testing or office visit) and 3% were advised to immediately seek care emergency department. 83% of patients who were advised to stay home did not require in-person visits.Meaning: Physician-directed telehealth services conserve scarce resources and provide effective, equitable care during a pandemic without compromising patient safety.ABSTRACT Importance: Severe acute respiratory syndrome coronavirus (SARS-CoV-2) and the associated coronavirus disease of 2019 (COVID-19) have presented immense challenges for health care systems. Many regions have struggled to adapt to disruptions to health care practice and employ systems that effectively manage the demand for services.Objective: To examine the effectiveness of the first five weeks' of a 24/7 physician-staffed COVID-19 hotline.Design: Cohort study using electronic health records.Setting: A single large health care system in Northeast Ohio.Participants: During 5 weeks of operation, 10,112 patients called the hotline (callers) and were evaluated by a registered nurse (RN) using standardized protocols. Of these, 4,213 (42%) were referred for a physician telehealth visit (telehealth patients). The mean age of callers was 42 years. 67% were female, 51% white, and 46% were on Medicaid or uninsured.Intervention: Physician telehealth visits for COVID-19. Main Outcomes and Measures:We describe clinical diagnosis, patient characteristics (age, sex race/ethnicity, smoking status, insurance status), and visit disposition. We use logistic regression to evaluate associations between patient characteristics, visit disposition and subsequent emergency department use, hospitalization, and SARS-Cov-2 PCR testing. Results:Common caller concerns included cough, fever, and shortness of breath. Most telehealth patients (79%) were advised to self-isolate at home, 14% were determined to be unlikely to have COVID-19, 3% were advised to seek emergency care, and 4% had miscellaneous other dispositions. A total of 287 (7%) patients had a subsequent ED visit, and 44 (1%) were hospitalized with a COVID-19 diagnosis. Of the callers, 482 (5%) had a COVID-19 test reported with 69 (14%) testing positive. Among patients advised to stay at home, 83% had no further face-to-face visits. In multivariable results, only a physician recommendation to seek emergency care was associated with emergency room use (OR=4.73, 95%CI 1.37-16.39, p=.014). Only older age was associated with having a positive test result. Conclusions and Relevance:Robust, physician-directed telehealth services can meet a wide range of needs during the acute phase of a pandemic, conserving scarce resources such as personal protective equipment and testing sup...

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“…This has left AMCs to determine how to balance increasing demands on medical services while maintaining safe learning environments that provide meaningful educational experiences. Put to task, medical educators worldwide have shared their experiences on the pandemic responses of their respective AMCs with insights primarily falling along three main axes: clinical service provision, preserving resident health, and educational continuity [6][7][8][9][10]. Moreover, an expanding body of literature on innovative educational strategies, trainee perspectives, and personal reflections of educational leaders has further enriched our understanding of the scale and nature of challenges faced by AMC's [11][12][13][14][15][16][17].…”

Section: Background and Need For Innovationmentioning

confidence: 99%

Residency training in the time of COVID-19: A framework for academic medical centers dealing with the pandemic

Abdel-Razig¹,

Ahmad²,

Shkoukani³

et al. 2020

Perspect Med Educ

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Background As cases of COVID-19 climb worldwide, academic medical centers (AMCs) are scrambling to balance the increasing demand for medical services while maintaining safe learning environments. The scale and nature of the current pandemic, limitations on key resources, risks of transmission, and the impact on trainee wellbeing pose additional challenges to AMCs. We propose a framework for AMCs to utilize in facilitating health system, organization and program-level adjustments to meet the needs of medical trainees during the pandemic. Approach In February 2020, we developed a three-level approach to the pandemic response of training programs at our AMC. The first level involved AMC alignment and engagement with regulatory stakeholders. The second level utilized the graduate medical education committee and leveraged organizational functions such as human resources, finance, and clinical departments. The third level of intervention focused on common approaches used by programs to ensure continuity of learning in the context of dynamic changes in workflows and service operations. Evaluation Outcomes at each level are reported. These include the co-development of a national framework on medical trainee responses to COVID-19, the composition of an operational guidance document, organizational protocols to accommodate novel challenges posed by the pandemic, and multiple program-level interventions. Reflection This methodical approach, employed during a global crisis, was critical in facilitating interventions required to fulfill the mission of AMCs. Future steps include assessing the impact of these changes on trainee performance and the applicability of the approach in diverse settings.

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Regional Strategies for Academic Health Centers to Support Primary Care During the COVID-19 Pandemic: A Plea From the Front Lines

Cited by 16 publications

References 2 publications

Description of a Multi-faceted COVID-19 Pandemic Physician Workforce Plan at a Multi-site Academic Health System

Description of a Multi-faceted COVID-19 Pandemic Physician Workforce Plan at a Multi-site Academic Health System

On the Front (Phone) Lines: Results of a COVID-19 Hotline in Northeast Ohio

Residency training in the time of COVID-19: A framework for academic medical centers dealing with the pandemic

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Regional Strategies for Academic Health Centers to Support Primary Care During the COVID-19 Pandemic: A Plea From the Front Lines

Cited by 16 publications

References 2 publications

Description of a Multi-faceted COVID-19 Pandemic Physician Workforce Plan at a Multi-site Academic Health System

Description of a Multi-faceted COVID-19 Pandemic Physician Workforce Plan at a Multi-site Academic Health System

On the Front (Phone) Lines: Results of a COVID-19 Hotline in Northeast Ohio

Residency training in the time of COVID-19: A&nbsp;framework for academic medical centers dealing with the pandemic

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Residency training in the time of COVID-19: A framework for academic medical centers dealing with the pandemic