ABSTRACT
The Covid-19 pandemic dramatically catalyzed use of telehealth and other virtual care modalities. Now, as virtual care delivery has become more widely accepted and increasingly used as a primary mode of care delivery, clinical contact centers (CCCs) are emerging as an important venue for access to a growing array of virtual care and other services. The Veterans Affairs Health System (VHS) has found that its call centers, which were historically used to offer patients inbound telephonic communication, have provided a foundation for regional CCCs using technology to offer patients bidirectional, multichannel communication (e.g., voice, video, text, chat) that improves health care accessibility, care coordination, and patient communication. In addition, the VHS has used the CCCs to leverage resources across care settings when managing public health emergencies. In May 2020, the VHS's Office of Veterans Access to Care led an initiative to modernize and consolidate the 87 individual Veterans Affairs Medical Center (VAMC) call centers into 18 regional CCCs serving all 171 VAMCs. Although still a work in progress, the Veterans Affairs CCC initiative — branded VA Health Connect — has expanded access to primary care, pharmacy services, emergency medicine, and mental health services. VA Health Connect is now responding to more than 40 million inquiries per year, with improvements in speed to answer, abandonment rates, and first-contact resolution. The authors describe some lessons learned in the implementation of VA Health Connect about how to involve people, processes, and technology to enhance patient services. The application of human-centered design can inform technology adoption and configuration of multichannel (omnichannel) communications. Critical to the success of VA Health Connect has been the incorporation of change management, effective mechanisms for deploying care delivery technology, and the importance of standardized data for performance improvement and organizational learning.
ABSTRACT
BACKGROUND AND AIMS: The coronavirus disease 2019 (COVID-19) pandemic has had profound impacts worldwide, including on the performance of GI endoscopy. We aimed to describe the performance and outcomes of pre-endoscopy COVID-19 symptom and exposure screening and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) nucleic acid amplification testing (NAAT) across the national Veterans Affairs healthcare system and describe the relationship of SARS-CoV-2 NAAT use and resumption of endoscopy services. METHODS: COVID-19 screening and NAAT results from March 2020 to April 2021 were analyzed to determine use, performance characteristics of screening, and association between testing and endoscopic volume trends. RESULTS: Of 220,891 completed endoscopies identified, 115,890 (52.5%) had documented preprocedure COVID-19 symptom and exposure screenings and 154,127 (69.8%) had preprocedure NAAT results within 7 days before scheduled endoscopy. Of 131,894 total canceled endoscopies, 26,475 (20.1%) had screening data and 28,505 (21.6%) had SARS-CoV-2 NAAT results. Overall, positive NAAT results were reported in 1.8% of all individuals tested and in 1.3% of those who screened negative. Among completed and canceled endoscopies, COVID-19 screening had a 34.6% sensitivity (95% confidence interval [CI], 32.4%-36.8%) and 96.4% specificity (95% CI, 96.2%-96.5%) when compared with NAAT. COVID-19 screening had a positive predictive value of 15.0% (95% CI, 14.0%-16.1%) and a negative predictive value of 98.7% (95% CI, 98.7%-98.8%). There was a very weak correlation between monthly testing and monthly endoscopy volume by site (Spearman rank correlation coefficient = .09). CONCLUSIONS: These findings have important implications for decisions about preprocedure testing, especially given breakthrough infections among vaccinated individuals during the SARS-CoV-2 delta and omicron variant surge.
Subject(s)
COVID-19 , Nucleic Acids , Veterans , COVID-19/diagnosis , COVID-19/epidemiology , Endoscopy, Gastrointestinal , Humans , Practice Patterns, Physicians' , SARS-CoV-2ABSTRACT
STUDY OBJECTIVES: The field of sleep medicine has been an avid adopter of telehealth, particularly during the COVID-19 pandemic. The goal of this study was to assess patients' experiences receiving sleep care by telehealth. METHODS: From June 2019 to May 2020, the authors recruited a sample of patients for semi-structured interviews, including patients who had 1 of 3 types of telehealth encounters in sleep medicine: in-clinic video, home-based video, and telephone. Two analysts coded transcripts using content analysis and identified themes that cut across patients and categories. RESULTS: The authors conducted interviews with 35 patients and identified 5 themes. (1) Improved access to care: Patients appreciated telehealth as providing access to sleep care in a timely and convenient manner. (2) Security and privacy: Patients described how home-based telehealth afforded them greater feelings of safety and security due to avoidance of anxiety-provoking triggers (eg, crowds). Patients also noted a potential loss of privacy with telehealth. (3) Personalization of care: Patients described experiences with telehealth care that either improved or hindered their ability to communicate their needs. (4) Patient empowerment: Patients described how telehealth empowered them to manage their sleep disorders. (5) Unmet needs: Patients recognized specific areas where telehealth did not meet their needs, including the need for tangible services (eg, mask fitting). CONCLUSIONS: Patients expressed both positive and negative experiences, highlighting areas where telehealth can be further adapted. As telehealth in sleep medicine continues to evolve, the authors encourage providers to consider these aspects of the patient experience. CITATION: Donovan LM, Mog AC, Blanchard KN, et al. Patient experiences with telehealth in sleep medicine: a qualitative evaluation. J Clin Sleep Med. 2021;17(8):1645-1651.