ABSTRACT
Background: The COVID-19 pandemic entered the USA in early 2020. As of March 16, our local CF infrastructure came to a complete halt. Clinic cancellations, minimum staff coverage, and stay-at-home recommendations were enacted. The CF center decreased from 25 clinic visits per week to 4 or less. Two significant barriers to implementing telehealth management occurred: 1) absence of institutional telehealth infrastructure;and 2) hybrid nature of the CF center team with university faculty and hospital staff, resulting in the adoption of different pandemic work and management schedules. Consequently, the CF team had to test and implement a viable and effective telehealth model to maintain adequate patient management. The SMART Aim was to implement a meaningful, remote, multidisciplinary care management for people with CF from 0% to 80% by May 31, 2020. Methods: Using the Model for Improvement, the ambulatory in-person care process was adapted for telehealth visits. The team focused on minimizing gaps in communication and information sharing to address reduced working schedules and difficulties in accessing medical information from home. The team utilized plan-do-study-act cycles to test and adapt pre-visit planning (PVP), preparation of patient/family (P/F), visit note sharing, testing of off-the-shelf remote communication tools, including texting (iOS and Android messaging, WhatsApp, etc), and video apps (Google's Duo & Meet, FaceTime, Zoom, Doxy.me, Spike, and Jitsi Meet). Data collection included the number of scheduled visits, visits converted to telehealth, pre-visit contacts, completed visits, reschedules, “no answers,” and telehealth visits carried out with single (provider only) or with multiple members of the team. We used an informal survey to assess staff satisfaction and an email survey to determine P/F satisfaction. Results: Changes in processes occurred using rapid-cycle testing. PVP allowed the team to coproduce P/F preference for contact and specific instructions about the upcoming telehealth visit. Having the MD make the call first allowed the ability to control and proceed with the visit by phone or video-based (offered on diverse formats) with direct feedback from the P/F. The use of group messaging during the telehealth visit helped the team with patient management. The sequential discipline calls increased the likelihood of connecting with the P/F. Barriers for P/F included limited broadband access, limited knowledge of video app solutions, and lack of cellular service. Team's obstacles included limited availability (reduced staffing) and institutional restrictions on working from home. Since adopting the MD telephone/video visit method with team participation via group messaging and calling P/F sequentially, team participation reached 89%. Staff satisfaction was reported as positive. P/F survey indicated 100% agreed it was not a burden to receive multiple calls, and 100% agreed it was helpful to speak to other CF team members during the call period. Conclusions: A multidisciplinary telehealth visit process was tested, adapted, and found to meet patients' and team members' needs. Institutional barriers can be overcome by brainstorming and testing new ideas. Future steps include assessing reliability and gaps in management and outcomes.