ABSTRACT
Introduction: Tracking adaptations during implementation can help assess and interpret outcomes. The framework for reporting adaptations and modifications-expanded (FRAME) provides a structured approach to characterize adaptations. We applied the FRAME across multiple health services projects, and developed an analytic approach to assess the impact of adaptations. Methods: Mixed methods analysis of research diaries from seven quality improvement (QI) and research projects during the early stages of the COVID-19 pandemic. Using the FRAME as a codebook, discrete adaptations were described and categorized. We then conducted a three-step analysis plan: (1) calculated the frequency of adaptations by FRAME categories across projects;(2) qualitatively assessed the impact of adaptations on project goals;and (3) qualitatively assessed relationships between adaptations within projects to thematically consolidate adaptations to generate more explanatory value on how adaptations influenced intervention progress and outcomes. Results: Between March and July 2020, 42 adaptations were identified across seven health services projects. The majority of adaptations related to training or evaluation (52.4%) with the goal of maintaining the feasibility (66.7%) of executing projects during the pandemic. Five FRAME constructs offered the most explanatory benefit to assess the impact of adaptations on program and evaluation goals, providing the basis for creating an analytic approach dubbed the "A-FRAME,” analysis of FRAME data. Using the A-FRAME, the 42 adaptations were consolidated into 17 succinct adaptations. Two QI projects discontinued altogether. Intervention adaptations related to staffing, training, or delivery, while evaluation adaptations included design, recruitment, and data collection adjustments. Conclusions: By sifting qualitative data about adaptations into the A-FRAME, implementers and researchers can succinctly describe how adaptations affect interventions and their evaluations. The simple and concise presentation of information using the A-FRAME matrix can help implementers and evaluators account for the influence of adaptations on program outcomes. © 2023 The Authors. Learning Health Systems published by Wiley Periodicals LLC on behalf of University of Michigan.
ABSTRACT
Objective: To investigate adoption and perceived utility of video visits for new and return patients across neurologic subspecialties. Background: Prior to the COVID-19 pandemic, utilization of teleneurology for ambulatory patients was limited. The pandemic presented an opportunity to evaluate ambulatory teleneurology visits for new and return patients in a suburban academic multi-subspecialty practice at a large scale. Design/Methods: Adoption of video visits was assessed using clinician-level scheduling data from 3/22-5/16/2020. Perceived utility of video visits was explored via clinician survey and semi-structured interviews with clinicians and patients/caregivers. Findings were compared across 5 subspecialties (epilepsy, headache, memory, movement disorders, and neuromuscular) and 2 visit types (new versus return). Results: Video visits were adopted rapidly;all clinicians (n=65) integrated video visits into their workflow With in the 6 weeks and 92% of visits were conducted via video. Utility of video visits was higher for return than new patient visits, as indicated by surveyed (n=48) and interviewed clinicians (n=30). Headache and memory had the highest adoption of video visits for both return and new patient visits. Neuromuscular had the lowest adoption of video for new patient visits and movement disorders for return patient visits. Clinicians felt it was easier to achieve similar physical exam, patient-clinician rapport, and perceived quality of care over video for return rather than new patient visits. Most patients/caregivers interviewed were satisfied with the care provided via video regardless of visit type, with the main limitation being the physical exam. Conclusions: Teleneurology was robustly adopted for both new and return patients during the COVID-19 pandemic. Return visits were preferred over new patient visits, but both were feasible. Headache and memory disorders had the highest levels of adoption between visit types potentially related to less dependence on physical examinations. We provide a foundation for developing targeted guidelines for sustaining teleneurology in ambulatory care post-pandemic.