Article Figures & Data
Tables
Clinic Clinicians (N, FTE) Number of Unique Patients Payer Mix HMO/PPO Medicare Medicaid Tricare Other* 1 47 (9) 19,408 59% 20% 18% 1% 2% 2 9 (6) 11,498 66% 24% 5% 3% 1% 3 15 (8) 13,316 51% 36% 6% 6% 1% 4 10 (7) 9204 56% 24% 12% 6% 2% 5 9 (4) 8207 67% 19% 9% 3% 1% ↵* Unspecified, self-pay, indigent care program.
Abbreviations: FTE, Full Time Equivalent; HMO, Health Maintenance Organization; PPO, Preferred Provider Organization.
- Table 2.
Factors by RE-AIM Dimension That Affected Telemedicine Use and Usefulness: Concordance and Discordance by Participant Role
Reach: Number, Proportion, and Representativeness of Patient's Participating in Telemedicine Concordance/discordance: Technology: All groups reported about technology accessible for most patients, but for some patients not at all; patients noted little challenges with technology contrary to clinician/staff perceptions (likely a sampling issue).
Convenience: Some groups mentioned this while others did not.
Safety: Safety as a motivator was predominantly mentioned by the patients and not practice groups.
Mindset: Clinicians, staff, and patients acknowledged similar limitations in mindset/willingness to engage in virtual care.
Missed opportunities: Patients and clinicians both recognize not all patients are appropriate for telemedicine.
Summary: Overall patients and clinicians had more comments about reach aspects than other stakeholders.
Effectiveness: The Ability of Telemedicine to Impact on Patient Outcomes and Quality of Care Concordance/discordance: Communication: Across groups, the relational aspect was not as effective at times with telemedicine as compared to in person, feels different.
Visit appropriateness: Patients and practice members alike noted the importance of the health concern and the appropriateness for telemedicine. For the right visit type, telemedicine was deemed as equivalent to in person.
Quality: Patients noted that telemedicine and in-person visits were of similar quality level more so than practice member groups.
Visit appropriateness: Most similar across groups on visits requiring physical exam being inappropriate for telemedicine.
Summary: Many similarities across groups. Lack of comments from administrative staff about effectiveness specifically.
Adoption: Number, Proportion, and Representativeness of Settings and Clinicians and Staff Willing to Initiate Telemedicine Concordance/discordance: Clinician wellness: Patients and clinicians noted this issue while other groups did not.
Workflow, equipment, home environment, and training: Noted by all practice groups but not patients; varied by the individual's situation; more variation across and within groups about how equipment, home environment, previous training affected adoption and how well telemedicine functioned.
Summary: Overall less commentary on adoption from patients, although some recognized how it may affect clinicians.
Implementation: Different Stakeholders' Use of Telemedicine and Implementation Strategies; Fidelity, Consistency, and Time Investment of Telemedicine Delivery in the Practice Concordance/discordance: Workflow: Patients and different team members saw the implementation process from different perspectives, though both patients and clinic members suggested that previsit steps to ensure the visit type was appropriate and optimized for telemedicine (e.g. length of visit) would benefit the process; clinicians, clinical staff, and administrative staff noted difficulty completing paperwork and accessing needed resources when working remotely.
Communication: All types of practice members noted difficulties with remote communication across team members; clinicians, clinical staff, and administrative staff noted communication challenges across different locations (clinic, remote).
Technology: All practice members worked on improving technology issues for patients. Some system improvements needed from multiple perspectives.
Visit appropriateness: Both clinicians and patients had understanding of appropriateness of different complaints and patient characteristics for telemedicine.
Summary: Many issues affected quality implementation; an area rich with discussion about how to make telemedicine work effectively across all groups.
Maintenance: Sustainment and Institutionalization of Telemedicine beyond an Initial Implementation Period Concordance/discordance: Future willingness and needs: Agreement by some groups that telemedicine is a benefit to offer to patients; administrators and clinicians recognize the need for continued payment and approval for use.
Convenience, reduction of burden, and safety: Across stakeholders, desire for some mix of in-person and telemedicine to manage distancing, aid with convenience/burnout.
Workflow: Clinical and administrative staff report that changes to workflow needed to manage patients in physical (i.e. clinic) space and schedule telemedicine versus in person, prep for visits.
Summary: Attention focused on how this will work in the future, and what issues will be important to have telemedicine continue past the pandemic.
Factor Description “Must Have” Condition Flexibility Technology System capacity to do video or phone visits; equipment to conduct the visit; adequate technological supplies, Internet access and bandwidth Must have some minimum system on both sides (patient and provider/staff) Some visits had to be converted to phone with voice only Mindset Knowledge, comfort, and willingness with doing a telemedicine visit (exclusive of technology issues) All must be willing to engage Some patients or clinicians not satisfied with a visit lacking video capabilities, physical exam, sufficient quality of clinician–patient communication Health issue The health condition to be addressed Ability to do what is needed for the visit (ie, physical exam, discussion, labs, and so forth) Some assessments can be modified and some tests not required to maintain a high-quality visit
