Enhanced telemedicine in a mobile integrated health program to improve healthcare access during Covid-19 pandemic: OJNI

ABSTRACT

Background: When the COVID-19 pandemic struck, primary care and specialist visits declined.  During the pandemic, Baltimore City Mobile Integrated Health (MIH) continued with targeted home visits among complex patients to help reduce hospital readmission rates. Many provider offices and specialists were closed for in-person clinic visits, creating disruption in continual care of chronic disease. To fill in gaps in care, MIH sought to facilitate these visits via telemedicine for their complex patient population. Methods: A retrospective chart review of MIH-enrolled patients was performed from March 2020 to August 2020. State health information exchange systems were also reviewed for hospital contact. To evaluate if the telemedicine visit was effective in reducing the readmission rate, the study compared the risk-adjusted readmission rate and chi square analysis of patients who received a telemedicine visit with their primary care/specialist as a part of their MIH visit versus MIH patients who did not. Results: From March 2020-August 2020, telemedicine was utilized 26 times for 14 patients to connect with their providers. The risk-adjusted readmission rate for MIH patients that received telemedicine primary care/specialist visits were 7.7%;the rate for MIH patients who did not was 16%.  Chi square analysis did not reveal statistical significance among the two groups. Conclusion: Flexible and innovative use of telemedicine technology improves team communication and can also be used to facilitate existing care relationships between underserved populations and their care providers. The University of Maryland Medical Center (UMMC) partnered with the Baltimore City Fire Department (BCFD) to form Mobile Integrated Health (MIH) in 2018. This partnership aims to support medically complex patients’ transition to home after hospital admissions. This innovative, community-based program supports the health of individuals through a comprehensive, multidisciplinary care model that provides patient care outside the hospital setting. The program is designed to reduce health disparities, decrease emergency department visits, and prevent hospital readmissions. One of the main objectives for this MIH program is to have patients connect with their primary care providers (PCPs) shortly after discharge so that the PCPs can continue to manage their chronic health conditions and medications and prevent readmission to the hospital. Prior to March 2020, none of the patients enrolled in UMMC-BCFD MIH utilized telemedicine for their medical visits (Mobile Integrated Health Community Paramedicine Program, 2020). During the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) issued guidance advising patients and health care providers to practice social distancing and encouraged the use of telehealth (Koonin et al., 2020). A study conducted by the Department of Veteran Affairs (VA) found that there was a 56% decrease in in-person outpatient visits during the COVID-19 pandemic (Baum, et al., 2021). However, the UMMC-BCFD MIH program remained in operation with no change in staffing or practice. With the need to connect patients with their PCPs, the UMMC-BCFD MIH program needed to pivot their normal operations to continue to meet the needs of the patients. A retrospective chart review was completed to evaluate the enrollment rate of visits facilitating PCP and/or specialist encounters and if in-person visits impacted hospital re-admission rates among this population. Prior to the pandemic, patients that were enrolled in the MIH program regularly saw their PCPs in-person from 40-80% of the time during their enrollment. However, when COVID restrictions began, those in-person visits decreased to about 20% of the enrolled patients seeing their PCPs. The MIH program was able to change its normal operation to connect patients to primary care providers and specialists via telemedicine to meet the needs of medically complex patients during a pandemic.