CAN YOU HEAR AND SEE ME NOW? A TELEMEDICINE QUALITY IMPROVEMENT PROJECT IN A ARGE, URBAN SAFETY NET HEALTH SYSTEM

ABSTRACT

BACKGROUND: Since the onset of the COVID-19 pandemic, healthcare systems have faced significant barriers to providing quality primary care, particularly as practices shifted to telemedicine modalities without established technical and educational frameworks for patients, teams, and clinicians. We created an iterative quality improvement project with Unannounced Standardized Patients (USPs) to explore variation in telehealth practices across three public ambulatory care clinics. METHODS: Clinical leadership designed two USP cases reflective of local patient populations and their common clinical needs. USPs portrayed either;(1) a 40-45-year-old Black male with hypertension, or (2) a 40-45-year-old Latina with an asthma exacerbation and hypertension. Both were vaccine hesitant. USPs evaluated visit workflow and clinician's communication skills across core domains (Table 1). After each visit, the USPs completed a behaviorally anchored checklist. Domain summary scores were calculated as mean percent marked “well done.” A t-test was used to compare scores across phases and cases. RESULTS: 60 visits (48 video, 12 audio-only) were conducted in two phases (May-August 2021;September-December 2021). Of the 24 USPs (18 calls, 9 texts) contacted prior to their visit, only 4 spoke directly to a care team member. 74% of USPs recommended the clinic. There were no significant differences in domain scores between phases or cases (Table 1). Most clinicians (82% in both phases) introduced the topic of the COVID-19 vaccine appropriately. Regarding screening, most providers asked about smoking (79%) and alcohol use (72%), but few screened for vaping (22%) or depression (4%). 70% of clinicians or care teams replied to a MyChart portal message that was sent by the USP to the care team after the visit. CONCLUSIONS: Findings highlight opportunities for system-based change to optimize telehealth care (particularly the integration of team members in previsit planning, standardized screenings, and patient follow-up). Data across phases indicate sustained need for quality improvement efforts;reviewing comparative data with clinic leadership will inform further evaluation of health systems and educational methods.