Multispecialty Physician Networks: Improved Quality and Accountability - The ...EvidenceNetwork.ca
Multispecialty Physician Networks: Improved Quality and Accountability - The “Health Care Neighbourhood”
by Thérèse A. Stukel, Rick Glazier, Sue Schultz, Jun Guan Institute for Clinical Evaluative Sciences Toronto
Funded by: CIHR Emerging Team Grant in Applied Health Services and Policy Research
Kamal Jethwani, MD, MPH
Corporate Manager - Research and Innovation
Partners Healthcare Center for Connected Health
iHT² CMIO Symposium Beverly Hills – Opening Keynote: Kamal Jethwani, MD, MPH, Corporate Manager – Research and Innovation, Partners Healthcare Center for Connected Health
Building A Chronic Care Management Program That Can ScaleVSee
Achieving 100% COVID Readiness with Chronic Care Telehealth
Chronically ill patients in the US account for 76% of all physician visits. They are also the most susceptible to COVID and COVID-related illnesses. With COVID variants on the rise, telehealth and remote patient monitoring (RPM) are essential to keeping these patients safe, while providing quality care and improving outcomes.
In addition, studies have shown that remote patient monitoring improves patient self-management and leads to earlier interventions. It can also reduce emergency hospital visits 30%. In 2015 Medicare began reimbursing clinicians for using remote patient monitoring technology to manage chronically ill patients with 2+ chronic conditions with Chronic Care Management (CCM) codes. In more recent years, it also began reimbursing remote patient monitoring (RPM) services for a wider range of patients.
Find out how you can become COVID ready by laying the foundations for a successful telehealth Chronic Care Management program on the next Telehealth Secrets webinar. Join us live with CEO Ajay Gehlot, MD, MBA of CareConnect Health–one of the largest primary care providers in the state of Georgia
Gamification as a means to manage chronic diseaseEngagingPatients
UPMC is exploring ways to better engage patients through shared decision making and new approaches to encourage patients and their families to take control of their health. This presentation describes a pilot program UPMC has initiated to leverage gamification as a means to manage chronic heart failure.
Multispecialty Physician Networks: Improved Quality and Accountability - The ...EvidenceNetwork.ca
Multispecialty Physician Networks: Improved Quality and Accountability - The “Health Care Neighbourhood”
by Thérèse A. Stukel, Rick Glazier, Sue Schultz, Jun Guan Institute for Clinical Evaluative Sciences Toronto
Funded by: CIHR Emerging Team Grant in Applied Health Services and Policy Research
Kamal Jethwani, MD, MPH
Corporate Manager - Research and Innovation
Partners Healthcare Center for Connected Health
iHT² CMIO Symposium Beverly Hills – Opening Keynote: Kamal Jethwani, MD, MPH, Corporate Manager – Research and Innovation, Partners Healthcare Center for Connected Health
Building A Chronic Care Management Program That Can ScaleVSee
Achieving 100% COVID Readiness with Chronic Care Telehealth
Chronically ill patients in the US account for 76% of all physician visits. They are also the most susceptible to COVID and COVID-related illnesses. With COVID variants on the rise, telehealth and remote patient monitoring (RPM) are essential to keeping these patients safe, while providing quality care and improving outcomes.
In addition, studies have shown that remote patient monitoring improves patient self-management and leads to earlier interventions. It can also reduce emergency hospital visits 30%. In 2015 Medicare began reimbursing clinicians for using remote patient monitoring technology to manage chronically ill patients with 2+ chronic conditions with Chronic Care Management (CCM) codes. In more recent years, it also began reimbursing remote patient monitoring (RPM) services for a wider range of patients.
Find out how you can become COVID ready by laying the foundations for a successful telehealth Chronic Care Management program on the next Telehealth Secrets webinar. Join us live with CEO Ajay Gehlot, MD, MBA of CareConnect Health–one of the largest primary care providers in the state of Georgia
Gamification as a means to manage chronic diseaseEngagingPatients
UPMC is exploring ways to better engage patients through shared decision making and new approaches to encourage patients and their families to take control of their health. This presentation describes a pilot program UPMC has initiated to leverage gamification as a means to manage chronic heart failure.
Implementation of Online Safety Incident Reporting System in a Tertiary Care Teaching Hospital by Dr. Bijoy Johnson, Dept. of Hospital Administration, KMC Manipal, India
AMA & MGMA Practice Innovation Challenge Winnershealth2dev
This slide provides descriptions for the 5 winners of the AMA & MGMA Practice Innovation Challenge. The winners were announced at the MGMA 2015 Annual Conference. Winners will work work with the AMA to develop their proposal into a module for the AMA Steps Forward Website.
Patients recognize the benefits of technology-enhanced care, yet only 1 out of 10 use remote patient monitoring today. Read three keys to adoption. https://accntu.re/3fnEy6r
Clinician Satisfaction Before and After Transition from a Basic to a Comprehe...Allison McCoy
Healthcare organizations are transitioning from basic to comprehensive electronic health records (EHRs) to meet Meaningful Use requirements and improve patient safety. Yet, full adoption of EHRs is lagging and may be linked to clinician dissatisfaction. In depth assessment of satisfaction before, during, and after EHR transition is rarely done. Using an adapted published tool to assess adoption and satisfaction with EHRs, we surveyed clinicians at a large, non-profit academic medical center before (baseline) and 6-12 months (short-term follow-up) and 12-24 months (long-term follow-up) after transition from a basic, locally-developed to a comprehensive, commercial EHR. Satisfaction with the EHR (overall and by component) was captured at each interval. Overall satisfaction was highest at baseline (85%), lowest at short-term follow-up (66%), and increasing at long-term follow-up (79%). This trend was similar for satisfaction with EHR components designed to improve patient safety including clinical decision support, patient communication, health information exchange, and system reliability. Conversely, at baseline, short-term and long-term follow-up, perceptions of productivity, ability to provide better care with the EHR, and satisfaction with available resources, were lower at both short- and long-term follow-up compared to baseline. Persistent dissatisfaction with productivity and resources was identified. Addressing determinants of dissatisfaction may increase full adoption of EHRs. Further investigation in larger populations is warranted.
Clinicians Satisfaction Before and After Transition from a Basic to a Compreh...Allison McCoy
Healthcare organizations are transitioning from basic to comprehensive electronic health records (EHRs) to meet Meaningful Use requirements and improve patient safety. Yet, full adoption of EHRs is lagging and may be linked to clinician dissatisfaction. In depth assessment of satisfaction before, during, and after EHR transition is rarely done. Using an adapted published tool to assess adoption and satisfaction with EHRs, we surveyed clinicians at a large, non-profit academic medical center before (baseline) and 6-12 months (short-term follow-up) and 12-24 months (long-term follow-up) after transition from a basic, locally-developed to a comprehensive, commercial EHR. Satisfaction with the EHR (overall and by component) was captured at each interval. Overall satisfaction was highest at baseline (85%), lowest at short-term follow-up (66%), and increasing at long-term follow-up (79%). This trend was similar for satisfaction with EHR components designed to improve patient safety including clinical decision support, patient communication, health information exchange, and system reliability. Conversely, at baseline, short-term and long-term follow-up, perceptions of productivity, ability to provide better care with the EHR, and satisfaction with available resources, were lower at both short- and long-term follow-up compared to baseline. Persistent dissatisfaction with productivity and resources was identified. Addressing determinants of dissatisfaction may increase full adoption of EHRs. Further investigation in larger populations is warranted.
Closing the Loop: Strategies to Extend Care in the EDEngagingPatients
This HIMSS15 presentation discusses the challenges faced in hospital emergency departments and offers insights for implementing a process to follow up with discharged ED patients to enhance outcomes and satisfaction,while optimizing utilization and reducing risk.
Implementation of Online Safety Incident Reporting System in a Tertiary Care Teaching Hospital by Dr. Bijoy Johnson, Dept. of Hospital Administration, KMC Manipal, India
AMA & MGMA Practice Innovation Challenge Winnershealth2dev
This slide provides descriptions for the 5 winners of the AMA & MGMA Practice Innovation Challenge. The winners were announced at the MGMA 2015 Annual Conference. Winners will work work with the AMA to develop their proposal into a module for the AMA Steps Forward Website.
Patients recognize the benefits of technology-enhanced care, yet only 1 out of 10 use remote patient monitoring today. Read three keys to adoption. https://accntu.re/3fnEy6r
Clinician Satisfaction Before and After Transition from a Basic to a Comprehe...Allison McCoy
Healthcare organizations are transitioning from basic to comprehensive electronic health records (EHRs) to meet Meaningful Use requirements and improve patient safety. Yet, full adoption of EHRs is lagging and may be linked to clinician dissatisfaction. In depth assessment of satisfaction before, during, and after EHR transition is rarely done. Using an adapted published tool to assess adoption and satisfaction with EHRs, we surveyed clinicians at a large, non-profit academic medical center before (baseline) and 6-12 months (short-term follow-up) and 12-24 months (long-term follow-up) after transition from a basic, locally-developed to a comprehensive, commercial EHR. Satisfaction with the EHR (overall and by component) was captured at each interval. Overall satisfaction was highest at baseline (85%), lowest at short-term follow-up (66%), and increasing at long-term follow-up (79%). This trend was similar for satisfaction with EHR components designed to improve patient safety including clinical decision support, patient communication, health information exchange, and system reliability. Conversely, at baseline, short-term and long-term follow-up, perceptions of productivity, ability to provide better care with the EHR, and satisfaction with available resources, were lower at both short- and long-term follow-up compared to baseline. Persistent dissatisfaction with productivity and resources was identified. Addressing determinants of dissatisfaction may increase full adoption of EHRs. Further investigation in larger populations is warranted.
Clinicians Satisfaction Before and After Transition from a Basic to a Compreh...Allison McCoy
Healthcare organizations are transitioning from basic to comprehensive electronic health records (EHRs) to meet Meaningful Use requirements and improve patient safety. Yet, full adoption of EHRs is lagging and may be linked to clinician dissatisfaction. In depth assessment of satisfaction before, during, and after EHR transition is rarely done. Using an adapted published tool to assess adoption and satisfaction with EHRs, we surveyed clinicians at a large, non-profit academic medical center before (baseline) and 6-12 months (short-term follow-up) and 12-24 months (long-term follow-up) after transition from a basic, locally-developed to a comprehensive, commercial EHR. Satisfaction with the EHR (overall and by component) was captured at each interval. Overall satisfaction was highest at baseline (85%), lowest at short-term follow-up (66%), and increasing at long-term follow-up (79%). This trend was similar for satisfaction with EHR components designed to improve patient safety including clinical decision support, patient communication, health information exchange, and system reliability. Conversely, at baseline, short-term and long-term follow-up, perceptions of productivity, ability to provide better care with the EHR, and satisfaction with available resources, were lower at both short- and long-term follow-up compared to baseline. Persistent dissatisfaction with productivity and resources was identified. Addressing determinants of dissatisfaction may increase full adoption of EHRs. Further investigation in larger populations is warranted.
Closing the Loop: Strategies to Extend Care in the EDEngagingPatients
This HIMSS15 presentation discusses the challenges faced in hospital emergency departments and offers insights for implementing a process to follow up with discharged ED patients to enhance outcomes and satisfaction,while optimizing utilization and reducing risk.
Yellowstone Landscape is a commercial landscaping company serving the Southern United States. This presentation provides examples of the value created by quality landscaping and concludes with an overview of Yellowstone Landscape's capabilities.
Martin Hefford
Sapere Research Group
(Friday, 10.00, Telehealth/mHealth)
See the related video: http://www.slideshare.net/secret/1msf1AYsNLJlSW
Congestive Heart Failure and Chronic Obstructive Pulmonary Disease are two chronic conditions that have important impacts on both the quality and length of life of individuals and on utilisation of health services. In the context of limited health funding, workforce restrictions, and an ageing population, there is increasing interest in the use of remote monitoring technologies to improve the quality of life of patients with these conditions, and to reduce unplanned use of hospital services.
In 2009 Lake Taupo Primary Health Organisation (PHO), Lakes District Health Board (DHB) and Healthcare of New Zealand Ltd, entered into a strategic partnership to pilot telehealth devices to support chronic care management in the Lake Taupo community, using a small randomised control trial approach, with ten patients in each arm. Sapere Research Group was commissioned to independently evaluate the 12 month pilot, and found good evidence that the telehealth remote monitoring technology was accepted by both Maori and non-Maori participants; that quality of life was significantly better in the telehealth group than in the control group; and some indications of a trend toward improved survival in the telehealth group. Hospitalisations were reduced in both the control (-19%) and telehealth group (-25%). Results should be considered tentative given the small numbers in the trial, but are consistent with findings of improved survival, quality of life and cost savings from recent international reviews. The impact of the telehealth intervention may have been partially masked by the simultaneous implementation of the Healthright disease management programme.
Sills MR. Overview of the SAFTINet Program. Presented to the Emergency Department Research Committee, Department of Pediatrics, University of Colorado School of Medicine. 6 January 2015.
Health Information Exchange ( usage and benefits )Htun Teza
Presentation for RADS 601 ( Health Informatics and Health Information Technology ) - 20/11/19
Student of Master of Science in Data Science for Healthcare ( International Program ) ( Clinical Epidemiology and Biostatistics, Mahidol University, Thailand )
By Marc Newell, MD. A discussion about the rapidly evolving TeleHealth program at Minneapolis Heart Institute that promises to increase access to and timeliness of specialty care in communities across the region. “This is an innovative strategy that allows more patients to be seen closer to home, and have more access to subspecialty care. We need to transform how and where we deliver care so we can focus on prevention and chronic disease management.”
Mobile and Telehealth Programs Evidence and Emerging TechnologiesP. Kenyon Crowley
Review of current evidence on telehealth and mobile health interventions effectiveness, and emerging innovations in this space, presented at executive education session.
The scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice and hence improve the quality and effectiveness of health services
Patient Engagement is growing in importance as consumer expectations of healthcare providers change and as portals and other technologies improve. Early studies show affects on outcomes for patient engagement technologies
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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RGC Telehealth, Megan Coffman - SLC 2015
1. Robert Graham Center:
Family Physician Characteristics,
Attitudes, and Beliefs Regarding
Implementing Telehealth Services
Megan Coffman, MS
November 7, 2015
2. Robert Graham Center
The Robert Graham Center aims to improve
individual and population healthcare delivery
through the generation or synthesis of
evidence that brings a family medicine and
primary care perspective to health policy
deliberations from the local to international
levels.
7. The Project
• The State of Telehealth in Primary Care
– Literature Review
– Expert Panel
– Survey of Family Physicians
Funded by Anthem,Inc.
8. What is Telehealth?
• Telehealth: the exchange of medical
information from one location to another
via electronic communications
9. Why Telehealth?
• Telehealth is shown to:
– expand patients access to care,
– increase continuity of care,
– improve coordination of care
– reduce healthcare costs, and
– improve health outcomes
• Some indication of low usage in primary
care
10. Highlights from the Literature
Review and Expert Panel
• There is very little research on telehealth in
primary care
• The literature indicates that patients
appreciate the convenience of access to
telehealth services, and are satisfied with the
care they receive remotely
• Patients see saving time and travel as
benefits of telehealth compared to in-person
care
11. Survey Objectives
• Measure penetration of telehealth into primary
care setting
– Hypothesis: low penetration
• Characterize Family Physicians (FPs) who use
telehealth
– Hypothesis: higher use in rural setting, larger
practices, and younger physicians
• Investigate Attitudes/Beliefs of FPs regarding
telehealth
– Hypothesis: Users have more favorable
attitudes/beliefs
12. Who did we ask?
• Survey of 5,000 randomly selected FPs
– AMA Physician Masterfile (2014) linked to
AAFP member list
– FPs in direct patient care
– Oversample rural 2:1
14. Survey Questions
• All Respondents
– Provider Characteristics
– Practice Characteristics
– Attitudes About Telehealth (Likert Scales)
• Users/Non-Users Separate
– Use of Telehealth (users only)
– Beliefs About Telehealth (similar but distinct)
(Likert Scales)
15. Telehealth Defined
Telehealth services defined as:
1. Primary care services: a physician providing
care for a patient via live interactive video
and/or
2. Primary care and specialist referral services: a
primary care provider consulting with a
specialist via live interactive video and/or
3. Store and Forward: sharing electronic patient
data between a primary care provider and
specialist across locations
16. Survey Data
• 1,557 survey responses were analyzed
– 1,630 surveys were returned (31% response rate)
– 53 surveys were returned but not used
• Non-unique ID
• Respondent indicated they did NOT engage in direct
patient care or did not answer this question
• Sample weights were used to ensure the
estimates computed were representative of
family physicians across the United States
17. Results: Demographics
• 15% had used telehealth services in the last 12
months (85% had NOT) (N=225)
• Telehealth users were more likely to
– rural setting (26% versus 12%, p<0.01)
– use an EHR (97% vs. 92%, p<0.01)
– work with six+ FPs (40% vs. 29%, p<0.01)
• Telehealth users were less likely to:
– work in a practice that is privately owned (22% versus
39%, p<0.01)
– Provide general primary care (76% vs. 86%, p<0.01)
18. Prevalence of Telehealth Use by Type of Service Used
Source: Robert Graham Center Analysis of 2014 AAFP Telehealth Survey of Family Physicians, N=225
20. Results: Attitudes and Beliefs
• Telehealth users and non-users agree:
– Telehealth improves access to care for my
patients. (89% users vs. 77% non-users,
p<0.01)
– Telehealth improves the continuity of care for
my patients. (75% vs. 68%, p<0.01)
– Patients prefer to see their doctor in person.
(83% vs. 94%, p<0.01)
21. Results: Barriers
• Which of the following are barriers to using
telehealth in your practice?
– Cost of equipment (35% users vs. 47% non-
users)
– Lack of training about how to use telehealth in
a family medicine practice (40% vs. 55%)
– Reimbursement by insurers (46% vs. 54%)
– Potential liability issues associated with the
use of telehealth (26% vs. 41%)
23. Limitations
• Survey Biases: Self-reported response &
recall (esp. in terms of frequency of use)
• Response rate of 31% and small sample
of telehealth users
• Close ended questions – with opened
“other” options
24. Discussion
• FPs see telehealth as enhancing access
to care and improving continuity of care
• Barriers impeding use are policy amenable
– offer new opportunities for training
– address implementation costs
– increase awareness of current reimbursement
– develop new ways to reimburse
25. Survey Study Conclusion
• FPs views of telehealth are generally
positive
• Barriers to larger adoption remain
• Small but significant number of family
physicians who are providing telehealth
services for patients
26. What’s Next?
• A survey of Blue Cross, Blue Shield
patients in California and Ohio measuring
patient satisfaction
• A survey of Family Medicine Residency
Directors
27. Thank You and More
• To learn more about the Robert Graham
Center’s work, visit our website:
http://www.graham-center.org/rgc/home.html
• If you have specific questions on the
telehealth project, email me at:
mcoffman@aafp.org
Editor's Notes
Good morning everyone. Thank you for waking up early this Saturday morning to be here.
My name is Megan Coffman and I work at the Robert Graham Center.
Today, I am here to talk about some of our recent work on telehealth, but before I dive into that piece of the presentation I want to tell you a little bit about the Robert Graham Center.
We are division within the AAFP with editorial independence that allows us to pursue a variety of research projects.
We are a multi-disciplinary research team.
The team includes: clinician researchers
Health Economist
Sociologists
Geographers
Health Informaticists
Public health
This team includes HealthLandscape, an AAFP Enterprise that I’ll speak a bit more about shortly.
In addition to the Robert Graham Center staff, we are lucky to have Visiting Scholars and Fellows who also contribute to our work.
Under the umbrella of primary care research, we organize our work into these 8 categories.
You may be wondering how we tackle this variety of topics, and it is through our scholars, fellows, and key partnerships that enable us to cover this wide breadth of research interests.
Much of the Graham Center’s research has focused on secondary data analysis using large datasets like the Medicare claims data.
Recently, the team has started collecting primary data by fielding surveys and focus groups.
In addition to research, the team, mainly our colleagues at HealthLandscape develop and deploy mapping tools. You may be familiar with the MedSchool Mapper, UDS Mapper, or World Health Mapper.
This is a sample of some of the Robert Graham Center’s recent publications:
Beginning with Workforce projects to behavioral health integration to including social determinants into Electronic health records
Context: Telehealth offers the potential to facilitate the nation’s triple aim by shifting delivery of care to less expensive settings while improving access and convenience, yet the technology has limited penetration into the primary care arena. We focus on Family Physicians’ (FPs) perceptions and priorities in utilizing telehealth to provide health care services.
Objective: Identify FP provider and practice characteristics and attitudes of telehealth use stratified by users and non-users.
recent technological innovation in connecting clinicians to patients
Big national group thinks this is a part of the future and wonders why pc is not adopting usage – funded to take a deeper dive into the issue
However, penetration of telehealth into primary care setting is thought to be low and is poorly quantified in terms of the dimensions and barriers and is little understood. As there is little representative research.
ABSTRACT
Context: Telehealth offers the potential to facilitate the nation’s triple aim by shifting delivery of care to less expensive settings while improving access and convenience, yet the technology has limited penetration into the primary care arena. We focus on Family Physicians’ (FPs) perceptions and priorities in utilizing telehealth to provide health care services.
Survey of 5,000 randomly selected FPs
AMA Physician Masterfile (2014) linked to AAFP member list
Family Physicians in direct patient care
Oversample rural 2:1
Paper and on-line survey with reminders and incentive
Analysis: Descriptive statistics, numbers and %ages, bivariate analysis of statistically significant differences between groups
Paper and on-line survey with reminders and incentive. The survey included a variety of question formats including Likert scale, open questions, pre-defined responses. We tested the survey with a variety of Family Physicians to make sure the survey was well designed and questions were easy to answer.
paper survey was mailed out to 5,000 members and included a $2 bill incentive
Each survey had a unique identifier so we were able to see who completed the survey and then send follow-ups to individuals who had yet to complete the survey.
Literature review of peer-reviewed articles and grey sources,
expert panel discussion,
RTI survey methodology expert consultant, and
field testing of the questions
To assess the landscape we separate the sample into users and non-users
The survey included a variety of question formats including Likert scale, open questions, pre-defined responses. “LI-KERT”
Telehealth is the use of medical information exchanged from one location to another via electronic communications to improve a patient's health. We are using telemedicine and telehealth interchangeably. For the purpose of this project, we are defining telehealth services as:
1. Primary care services: this service involves a physician providing care for a patient (not necessarily a patient in their practice) through the use of live interactive video;
and/or
2. Primary care and specialist referral services: this service usually begins with a primary care provider who consults with a specialist through the use of live interactive video;
and/or
3. Sharing of diagnostic images, vital signs, video clips, or patient data between a primary care provider and specialist when the specialist and patient are not in the same location (sometimes referred to as store and forward).
Twenty of the surveys were returned due to an incorrect mailing address. Overall 1,630 responses were received. The final analysis sample consisted of 1,557 respondents who had a valid survey identifier (38 did not) and were engaged in direct primary care (35 were either not in direct patient care or did not answer this question).
Results: Of the 1,631 respondents, 15% indicated that they used teleheath services in the last 12 months. Users and non-users differed significantly in key ways; telehealth users were more likely to provide a wider scope of service, currently use an EHR, and were more likely to practice in an integrated health system. Self- identified telehealth users preferred offering visits through real time interactive video consultations with specialists and using telehealth for chronic disease management, mental health, and diagnosis and treatment over other types of consultations. Both groups reported reimbursement as a factor when considering whether to provide telehealth services. Users and non-users agreed that first time visits via telehealth were not preferably. Users and non-users both agreed that more research on the effectiveness of telehealth is needed.
The majority of the sample were male (62%, Table 1), Allopathic (84%), providing general primary care (84%).
The sample contained physicians from each age range with 28% having practices for ten or fewer years, 34% for 11 to 20 years, 24% for 21 to 30 years, and 14% for more than 30 years.
Overall 37% of the sample indicated that their practice was privately owned, 42% were owned by a hospital or health system, and 21% were owned by an integrated health system or had another ownership structure.
Telehealth users were statistically different from non-users in terms of their practice location, their EHR usage, the type of care they provide to their patients, the number of providers at their practice, and the ownership of their practice. Telehealth users were more likely to be located in an rural setting (26% versus 12%, p<0.001), to use an EHR (97% versus 92%, p=0.0056), to provide general primary care to their patients (76% versus 86%, p=0.0028), and to work in a practice with six or more family physicians (40% versus 29%, p=0.0047). Additionally, telehealth users were less likely to work in a practice that is not privately owned (22% versus 39%, p<0.001).
Does not sum to 100 because some did not answer the question.
Both groups reported reimbursement as a factor when considering whether to provide telehealth services.
Conclusions: FPs views of telehealth are positive. Three key barriers to adoption emerged: cost of equipment, lack of training, and need for reimbursement. There was a high degree of agreement among all survey respondents that effectiveness and implementation research is needed.
Both groups reported reimbursement as a factor when considering whether to provide telehealth services.
We attempt to overcome these barriers by … using our literature review of peer-reviewed articles and grey sources, our expert panel discussion, our RTI survey methodology expert consultant, and our field testing of the questions
Issues that must be addressed include creation of guidelines for clinical practice, definitions of quality and outcomes, demand for interoperable systems among the variety of users, assurance of privacy and security for the public and providers plus standardized reimbursement procedures. Pilot and demonstration programs should be established on a national level to create the information and knowledge base necessary to assure that telehealth represents an improvement in access and quality, or that it is at least is as good as current standards of care. Administrative issues including billing codes, reimbursement, licensing and credentialing, and appropriate physician, practitioner and staff training are all aspects that need to be addressed, codified and implemented.
Users and non-users differed significantly in key ways; telehealth users were more likely to provide a wider scope of service, currently use an EHR, and were more likely to practice in an integrated health system. Self- identified telehealth users preferred offering visits through real time interactive video consultations with specialists and using telehealth for chronic disease management, mental health, and diagnosis and treatment over other types of consultations. Both groups reported reimbursement as a factor when considering whether to provide telehealth services. Users and non-users agreed that first time visits via telehealth were not preferably. Users and non-users both agreed that more research on the effectiveness of telehealth is needed.