Increasing Utilization of an In-Home Remote Exam Device in a Complex Care Center

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety Pub Date : 2025-01-04 DOI:10.1016/j.jcjq.2025.01.001

Marie Pfarr MD (is Assistant Professor, Division of Pediatric Hospital Medicine, Department of Pediatrics, and Director of Complex Care (Teal Team), Heersink School of Medicine, University of Alabama at Birmingham.), Scott Callahan MD, FAAP (is Staff Physician, Division of General and Community Medicine, Department of Pediatrics, Cincinnati Children's Hospital, and Assistant Professor, Department of Pediatrics, University of Cincinnati College of Medicine.), Calise Curry (is Clinical Research Coordinator, Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center.), Karen Jerardi MD, MEd (is Co-Director, Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, and Professor, Department of Pediatrics, University of Cincinnati College of Medicine.), Kathleen Pulda (is Senior Telehealth Consultant, Center for Telehealth, Cincinnati Children's Hospital Medical Center.), Michelle Rummel (is Senior Telehealth Consultant, Center for Telehealth, Cincinnati Children's Hospital Medical Center.), Della Smith-Sokol (is Program Management Specialist, Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center.), Julie Stalf MSN, RN, CPN (is RN Clinical Manager, Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center.), Joanna Thomson MD, MPH (is Attending Physician, Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, and Associate Professor, Department of Pediatrics, University of Cincinnati College of Medicine.), Hadley Sauers-Ford MPH (is Senior Clinical Research Coordinator, Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. Please address correspondence to Marie A. Pfarr)

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Abstract

Background

The use of telehealth and remote exam devices for children with medical complexity (CMC) allows providers to engage with CMC in their home environment and alleviate caregiver burdens with in-person visits. The authors’ objective was to increase the percentage of telehealth visits in which a remote exam device was used in a complex care center from 0% to 50% over a six-month period.

Methods

This improvement work targeted a pediatric complex care center. The multidisciplinary quality improvement team developed key drivers to design Plan-Do-Study-Act cycles. Key drivers included access to device, timely identification of patients with devices, ease of connection, strong provider coaching, and caregivers and providers who were knowledgeable and motivated in using the device. Interventions focused on increasing distribution of devices, streamlining the scheduling process, establishing a device registry, education for caregivers and providers on using the device successfully, translating materials into common languages, and providing remote Internet connections. The primary outcome measure was the percentage of telehealth visits completed using the remote exam device. The researchers also tracked the number of devices distributed. The active intervention period was June 2021 to December 2021, with continued data collection through April 2022.

Results

The median percentage of telehealth visits using the remote exam device increased from 0% to 43% over the intervention period with non–special cause variation in device utilization in the subsequent four months. The most impactful intervention focused on increasing device distribution.