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COVID19 pandemic
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Clinicians slated for virtual visit rollout will be randomized (stratified by department) to either receive immediate virtual visit on-boarding (intervention arm) or delayed (3-months later) virtual visit on-boarding (control arm). The investigators plan to enroll no more than 200 clinicians.
Any clinician in a department selected by the Brigham Health Virtual Care team for access to virtual visits is eligible, unless s/he saw less than 20 patients monthly over the last 6 months.
The Brigham Health Virtual Care team will onboard all clinicians and provide virtual visit support as per their usual protocol. The primary study endpoint is third-available appointment, a well-adopted measure of access. Other secondary endpoints revolve around continuity, efficiency, utilization, safety, cost, and patient experience.
If enrolled in the intervention arm, the following steps will occur:
If enrolled in the control arm, the following steps will occur:
The investigators plan to follow patients of both clinician cohorts for a total of 6-months. The investigators will perform retrospective review of patient electronic health records and patients will receive a redcap survey (attached), an evaluation mechanism already employed by the Virtual Care team.
Again, aside from the initial randomization and retrospective data collection and analysis, all of the above would have occurred irrespective of this research protocol.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention | Experimental | If enrolled in the intervention arm, the following steps will occur:
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| Control | No Intervention | If enrolled in the control arm, the following steps will occur:
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Virtual Visit | Other | Clinicians will have a synchronous video visit with their patients. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Days until third available appointment | Number of days until the third available routine appointment, obtained at 12 o'clock each Friday (embargoed appointments not included). The mean of all of the weeks is a clinician's average number of days until the third available routine appointment. | Through study completion, an average of 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Days until first available appointment | Number of days until the next available routine appointment, obtained at 12 o'clock each Friday (embargoed appointments not included). The mean of all of the weeks is a clinician's average number of days until the next available routine appointment. | Through study completion, an average of 6 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| David Levine, MD, MPH, MA | Principal Investigator | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Brigham and Women's Hospital | Boston | Massachusetts | 02115 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 22674020 | Background | Wootton R. Twenty years of telemedicine in chronic disease management--an evidence synthesis. J Telemed Telecare. 2012 Jun;18(4):211-20. doi: 10.1258/jtt.2012.120219. | |
| 23977001 | Background | McLean S, Sheikh A, Cresswell K, Nurmatov U, Mukherjee M, Hemmi A, Pagliari C. The impact of telehealthcare on the quality and safety of care: a systematic overview. PLoS One. 2013 Aug 19;8(8):e71238. doi: 10.1371/journal.pone.0071238. eCollection 2013. |
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| ID | Term |
|---|---|
| D006333 | Heart Failure |
| D006973 | Hypertension |
| D003920 | Diabetes Mellitus |
| D020521 | Stroke |
| D006949 | Hyperlipidemias |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D014652 | Vascular Diseases |
| D044882 | Glucose Metabolism Disorders |
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Clinicians slated for virtual visit rollout will be randomized (stratified by department) to either receive immediate virtual visit on-boarding (intervention arm) or delayed (3-months later) virtual visit on-boarding (control arm).
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| Future capacity: percentage of open appointment slots |
Percentage of appointment slots that are open and available for booking patients over the next four weeks, obtained at 12 o'clock each Friday (embargoed appointments not included). The mean of all of the weeks is a clinician's future capacity. |
| Through study completion, an average of 6 months |
| Frequency of visits with the usual provider of care | Ratio of the number of visits to the most frequently seen provider to the total number of visits to all providers obtained each month. The mean of all of the months is a clinician's ratio. | Through study completion, an average of 6 months |
| Continuity of care index | The number of visits to each individual physician divided by the total number of visits the patient had overall obtained each month. The mean of all of the months is the continuity of care index | Through study completion, an average of 6 months |
| No show rate | Ratio of the number of no-show visits to total visit slots obtained each week. The mean of all of the weeks is a clinician's no show rate. | Through study completion, an average of 6 months |
| Visit time | In-person: face time with patient per pertinent EHR fields, obtained each week. The mean of all of the weeks is a clinician's visit time. Virtual: enter virtual waiting room to video stops, obtained each week. The mean of all of the weeks is a clinician's visit time. | Through study completion, an average of 6 months |
| Clinician volume per hour | Patients seen per hour, calculated at the end of the study. | Through study completion, an average of 6 months |
| Clinician volume per day | Patients seen per day, all calculated at the end of the study. | Through study completion, an average of 6 months |
| Clinician volume per month | Patients seen per month, all calculated at the end of the study. | Through study completion, an average of 6 months |
| Clinician volume per 6 months | Patients seen per 6 months, all calculated at the end of the study. | Through study completion, an average of 6 months |
| Slot utilization | Ratio of used slots to total slots, obtained each week. The mean of all of the weeks is a clinician's slot utilization. | Through study completion, an average of 6 months |
| Number of primary care visits | Number of primary care visits | Through study completion, an average of 6 months |
| Number of specialist visits | Number of specialist visits | Through study completion, an average of 6 months |
| Number of emergency department visits | Number of emergency department visits | Through study completion, an average of 6 months |
| Number of inpatient admissions | Number of inpatient admissions | Through study completion, an average of 6 months |
| Number of imaging studies | Number of imaging studies ordered | Through study completion, an average of 6 months |
| Number of labs ordered | Number of laboratory studies ordered | Through study completion, an average of 6 months |
| Number of medications prescribed | Number of medications prescribed | Through study completion, an average of 6 months |
| Patient Experience | Brigham Health Virtual Care team survey sent to participating patients | Sent electronically within 1 week of the in-person or virtual visit |
| Revenue from virtual or in-person visit | Revenue garnered by an individual clinician for her/his clinical activity, calculated per hour and per 6 months (denominator: total clinical hours worked). | Through study completion, an average of 6 months |
| 27410924 | Background | Dorsey ER, Topol EJ. State of Telehealth. N Engl J Med. 2016 Jul 14;375(2):154-61. doi: 10.1056/NEJMra1601705. No abstract available. |
| D008659 |
| Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D050171 | Dyslipidemias |
| D052439 | Lipid Metabolism Disorders |