Perceptions of video-based appointments from the patient's home: a patient survey.

BACKGROUND: We examined patient interest in a telehealth model in which the patient supplies the hardware and Internet connectivity to meet with a healthcare provider from his or her home via video call (video appointment). We hoped to understand prospectively the desirability, feasibility, and viability from the patient perspective. MATERIALS AND METHODS: A phone survey was conducted of a random sample of patients who had been seen in the outpatient setting at a single institution. The sample was stratified by proximity to the local institution with oversampling for patients living outside a 120-mile radius. RESULTS: Out of 500 total patients, 301 patients responded, and 263 met the inclusion criteria. Of those 263 respondents, 38% indicated "very likely" to accept an invitation to see their provider via video, 28.1% "somewhat likely," and 33.8% "not at all likely." Of respondents, 75% have broadband, although only 36% reported having a Web camera. The primary factors affecting willingness to participate in a video appointment include comfort in setting up a video call, age, and distance participants would have traveled for an in-clinic appointment. CONCLUSIONS: Patient survey data indicate that most patients are likely to be accepting of telehealth care to the home using video call and that most have the required technology. Nevertheless, there are still significant hurdles to effectively implement this adaptation of telehealth care as part of mainstream practice.

Health reform: a community experience using design research as a guide.

Meaningful health reform in the United States must improve the health of the population while lowering costs. In an effort to provide a framework for doing so, the Institute of Health Care Improvement created the triple aim, which encompasses the goals of (1) improving individual health and experience with the health care system, (2) improving population health, and (3) decreasing the rate of per capita health care costs. Current reform efforts have focused on the development of Patient-Centered Medical Homes (an innovative team-based model of care that facilitates a partnership between the patient's personal physician coordinating care throughout a patient's lifetime to maximize health outcomes), but these relatively narrow efforts are focused on office practice and payment methods and are not generally oriented toward community needs. We sought to apply design research in assessing a community opportunity to apply the triple aim as a strategy to transform health care delivery. Mixed methodology provides greater insight into the unexpressed health needs of individuals and into the creation of delivery systems more likely to achieve the triple aim. In a small, midwestern town, a mixed methods approach was used to assess community health needs to facilitate design and implementation of care delivery systems. The research findings suggest that health system design concepts should focus on the creation of health, not health care; foster simplicity; create nurturing relationships; eliminate user fear; and contain costs. These observations can be helpful to health care professionals who are developing new methods of care delivery and policymakers and payers contemplating new payment systems to achieve the goals of the triple aim.

Standardized care processes to improve quality and safety of patient care in a large academic practice: the Plummer Project of the Department of Medicine, Mayo Clinic.

There are opportunities to improve quality and safety of care provided to adult patients. The Plummer Project of the Department of Medicine at the Mayo Clinic (Rochester, MN, USA) is an initiative to redesign outpatient practice. We used multidisciplinary teams to standardize the tasks essential to improve patient care. With the initiative to standardize the rooming process, patient care and safety improved with greater accuracy of the medication list. The standardization also improved physician efficiency because trained clinical assistants helped address the needs of the patient. Physicians were satisfied by the new process and the technology enhancements. Clinical assistants were also highly satisfied by the training process. The quality and safety of patient care can be significantly improved by practice redesign. This practice redesign was satisfying for all, especially the patients, physicians and support team in our practice.

A nonresident cardiovascular inpatient service improves residents' experiences in an academic medical center: a new model to meet the challenges of the new millennium.

PURPOSE: Hospital practices in academic medical centers have fewer medical residents available to provide hospital care, necessitating alternative models for patient care. This article reports a new model for care of inpatients with cardiovascular diseases. METHOD: In 1998, a new nonresident cardiovascular patient care (Cardiology IV) service was implemented that used a team approach of staff attending cardiologists, cardiovascular fellows, midlevel practitioners (nurse practitioners and physician's assistants), and nurses to evaluate and treat patients. Standard dismissal information was collected for all patients dismissed in 1998 to compare diagnosis-related group, length of stay, in-hospital mortality, and 30-day readmission rates for Cardiology IV. These characteristics were compared with those for the remaining resident teaching services. Patients' satisfaction surveys from 1997 and 1998 were compared. Attending physicians' and internal medicine residents' satisfaction before and after the implementation of the new service was also compared. RESULTS: Staff and resident physicians were more satisfied with their hospital rotations after this intervention was introduced. Optimal patient care was maintained, and efficiency enhanced. Patients on Cardiology IV had a shorter length of stay compared with patients on the resident teaching service. CONCLUSIONS: This new hospital model has provided an alternative to patient care without the need for residents and protects education on the conventional teaching services. This model maintains optimal patient care and has resulted in enhanced satisfaction of attending staff and residents.