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      A descriptive analysis of an on-demand telehealth approach for remote COVID-19 patient screening

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          Abstract

          Introduction:

          COVID-19 requires methods for screening patients that adhere to physical distancing and other Centers for Disease Control and Prevention guidelines. There is little data on the use of on-demand telehealth to meet this need.

          Methods:

          The functional performance of on-demand telehealth as a COVID-19 remote patient screening approach was conducted by analysing 9270 patient requests.

          Results:

          Most on-demand telehealth requests (5712 of 9270 total requests; 61.6%) had a visit reason that was likely COVID-19 related. Of these, 79.1% (4518 of 5712) resulted in a completed encounter and 20.9% (1194 of 5712) resulted in left without being seen. Of the 4518 completed encounters, 19.1% were referred to an urgent care centre, emergency department or COVID-19 testing centre. The average completed encounter wait time was 26.5 min and the mean visit length was 8.8 min. For patients that completed an encounter 42.8% (1935 of 4518) stated they would have sought in-person care and 9.1% stated they would have done nothing if on-demand telehealth was unavailable.

          Discussion:

          On-demand telehealth can serve as a low-barrier approach to screen patients for COVID-19. This approach can prevent patients from visiting healthcare facilities, which reduces physical contact and reduces healthcare worker use of personal protective equipment.

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          Most cited references3

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          Hospital determinants of emergency department left without being seen rates.

          The proportion of patients who leave without being seen in the emergency department (ED) is an outcome-oriented measure of impaired access to emergency care and represents the failure of an emergency care delivery system to meet its goals of providing care to those most in need. Little is known about variation in the amount of left without being seen or about hospital-level determinants. Such knowledge is necessary to target hospital-level interventions to improve access to emergency care. We seek to determine whether hospital-level socioeconomic status case mix or hospital structural characteristics are predictive of ED left without being seen rates. We performed a cross-sectional study of all acute-care, nonfederal hospitals in California that operated an ED in 2007, using data from the California Office of Statewide Health Planning and Development database and the US census. Our outcome of interest was whether a visit to a given hospital ED resulted in left without being seen. The proportion of left without being seen was measured by the number of left without being seen cases out of the total number of visits. We studied 9.2 million ED visits to 262 hospitals in California. The percentage of left without being seen varied greatly over hospitals, ranging from 0% to 20.3%, with a median percentage of 2.6%. In multivariable analyses adjusting for hospital-level socioeconomic status case mix, visitors to EDs with a higher proportion of low-income and poorly insured patients experienced a higher risk of left without being seen. We found that the odds of an ED visit resulting in left without being seen increased by a factor of 1.15 for each 10-percentage-point increase in poorly insured patients, and odds of left without being seen decreased by a factor of 0.86 for each $10,000 increase in household income. When hospital structural characteristics were added to the model, county ownership, trauma center designation, and teaching program affiliation were positively associated with increased probability of left without being seen (odds ratio 2.09; 1.62, and 2.14, respectively), and these factors attenuated the association with insurance status. Visitors to different EDs experience a large variation in their probability of left without being seen, and visitors to hospitals serving a high proportion of low-income and poorly insured patients are at disproportionately higher risk of leaving without being seen. Our findings suggest that there is room for substantial improvement in this outcome, and regional interventions can be targeted toward certain at-risk hospitals to improve access to emergency care. Copyright © 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
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            The convenience revolution for treatment of low-acuity conditions.

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              Telehealth: the promise of new care delivery models.

              Telehealth possesses a significant potential to revolutionize healthcare delivery processes by challenging some of the long-held assumptions about healthcare delivery and by creating innovative alternative models. Those assumptions relate to the location-linked nature of healthcare and its episodic nature. Telehealth can challenge the assumption that healthcare is inextricably linked to the provider's location. Numerous models involving such approaches as interactive videoconferencing and store-and-forward technologies already exist. Telehealth also challenges the episodic nature of care. One example is provided by the models evolving from the convergence of three technologies: remote monitoring, electronic health records, and clinical decision support systems. Telehealth-based models of care can also lead to a reduced demand for services and greater efficiencies in the care process. These telehealth-enabled care delivery models have the potential to reduce the costs of care, improve quality, and mitigate provider shortages. However, the achievement of these goals is not straightforward. The current healthcare financing system is not designed to support such new models, and the existing healthcare culture is deeply ingrained within workflow processes and provider attitudes. A great deal of work remains to be done before the benefits of telehealth-based care delivery models are fully realized. Change is inherently risky but we must have the courage to assume the risk in order to create telehealth-driven innovations that lead to better and more cost-effective medical care for all.
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                Author and article information

                Journal
                J Telemed Telecare
                J Telemed Telecare
                JTT
                spjtt
                Journal of Telemedicine and Telecare
                SAGE Publications (Sage UK: London, England )
                1357-633X
                1758-1109
                August 2022
                August 2022
                August 2022
                : 28
                : 7
                : 494-497
                Affiliations
                [1 ]MedStar Health National Center for Human Factors in Healthcare, Washington, D.C., USA
                [2 ]Georgetown University School of Medicine, Washington, D.C., USA
                [3 ]MedStar Telehealth Innovation Center, Washington, D.C., USA
                [4 ]MedStar Institute for Innovation, Washington, D.C., USA
                Author notes
                [*]Raj M Ratwani, 3007 Tilden St. NW, Suite 6N, Washington, D.C. 20008, USA. Email: Raj.M.Ratwani@ 123456medstar.net
                Author information
                https://orcid.org/0000-0002-8623-6123
                Article
                10.1177_1357633X20943339
                10.1177/1357633X20943339
                9272041
                32698650
                7734baac-5a7c-44d3-a80b-c7043b7dae93
                © The Author(s) 2020

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                : 6 May 2020
                : 26 June 2020
                Categories
                RESEARCH/Original Articles
                Custom metadata
                ts19

                Medicine
                telehealth,covid-19,pandemic,screening
                Medicine
                telehealth, covid-19, pandemic, screening

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