QI in Pediatric Complex Care: Growing and Sustaining a Telehealth Practice During COVID-19

Purpose/Objectives: Our objective was to use the necessary changes in healthcare delivery during the COVID-19 pandemic to accelerate ongoing quality improvement initiatives in growing telemedicine services in our primary care practice that serves children with medical complexities.

We believe that synchronous and asynchronous telehealth care greatly benefits the patients and families of our highly complex pediatric population. However, despite our efforts, participation of families and staff members was low.

Our goal was to use this COVID-19 catalyst to create an enduring and sustainable telehealth presence and practice, and to do so, we invested in meeting both patient and staff needs.

Design/Methods: We used the Model for Improvement to guide PDSA cycles with the aim of increasing and sustaining telehealth usage by patients and staff. This would be achieved by increasing asynchronous patient portal contacts and finding equilibrium in virtual visits and office visits (compared to pre-COVID utilization). Success of incremental improvements was measured in feedback from staff and patients (both anecdotally and with surveys) and in tracking IT service requests for virtual visit support as compared to the number of virtual visits completed.

Results: Patients reported increased comfort in using the patient portal and confidence in participating in virtual visits. Percentage of patients completing office visits active to our patient portal increased from 72% pre-COVID to essentially 100% during and ongoing. Patients reported high satisfaction with virtual care and planned to use whenever possible and appropriate.

Staff demonstrated high levels of comfort with using the patient portal, confidence in conducting virtual visits, and working in remote environments.

Completed patient appointments have maintained an even split between in-clinic and virtual visits since August 2020.

IT service requests compared to virtual visit appointments peaked in April 2020 and maintained high levels over the course of the spring. They have returned to pre-COVID levels while virtual visit appointments are at a 10% increase from their pre-COVID average across our organization.

Conclusion/Discussion: We were able to maintain a level of patient and staff satisfaction, develop additional care coordination methods, and increase and sustain the percentage of virtual visits conducted. We had no clinic closures related to COVID-19 and little to no interruption of patient care.
The user experience is important. To successfully implement broad practice change, we must remember both patients and staff are the target audience. If both groups feel supported and championed, it elevates everyone’s experience.