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James JG, Wechsler LR, Blum CA, Bae CJ, Tropea TF. Provider Impressions of Inpatient Teleneurology Consultation. Neurol Clin Pract 2024; 14:e200296. [PMID: 38737514 PMCID: PMC11087028 DOI: 10.1212/cpj.0000000000200296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/30/2024] [Indexed: 05/14/2024]
Abstract
Background and Objectives Teleneurology usage has increased during the severe acute respiratory syndrome coronavirus 2 pandemic. However, studies evaluating physician impressions of inpatient teleneurology are limited. We implemented a quality improvement initiative to evaluate neurologists' impression following individual inpatient teleneurology consultation at a satellite hospital of a large academic center with no in-person neurology coverage. Methods A REDCap survey link was embedded within templates used by neurologists for documentation of inpatient consultations to be completed immediately after encounters. All teleneurology encounters with completed surveys at a single satellite hospital of the University of Pennsylvania Health System Neurology Department between May 10, 2021, and August 14, 2022, were included. Individual patient-level and encounter-level data were extracted from the medical record. Results A total of 374 surveys (response rate of 54.05%) were completed by 19 neurologists; 341 questionnaires were included in the analysis. Seven neurologists who specialized as neurohospitalists completed 231 surveys (67.74% of total surveys completed), while 12 non-neurohospitalists completed 110 (32.36%). The history obtained was rated as worse (14%) or the same (86%) as an in-person consult; none reported the history as better than nonteleneurology encounters. The physician-patient relationship was poor or fair in 25% of the encounters and good or excellent in 75% of visits. The overall experience was judged to be worse than in-person consultation in 32% of encounters, the same in 66%, and better in 2%. Fifty-one percent of providers responded that there were elements of the neurologic examination that might have changed their assessment and plan of care if performed in-person. Encounters with peripheral or neuromuscular-related chief complaints had the most inadequate examinations and worse overall experiences, while the most positive impressions of these clinical experiences were observed among seizure-related chief complaints. Discussion Determining best practices for inpatient teleneurology should consider the patient chief complaint to use teleneurology in scenarios with the highest likelihood of a positive experience. Further efforts should be made to the patient experience and to improve the remote examination to enhance the applicability of teleneurology to the full spectrum of inpatient neurologic consultations.
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James JG, Park J, Oliver A, Xie SX, Siderowf A, Spindler M, Wechsler LR, Tropea TF. Linked Patient and Provider Impressions of Outpatient Teleneurology Encounters. Neurol Clin Pract 2023; 13:e200159. [PMID: 37153752 PMCID: PMC10155606 DOI: 10.1212/cpj.0000000000200159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/27/2023] [Indexed: 05/10/2023]
Abstract
Background and Objectives Teleneurology is common in clinical practice partly due to the SARS CoV-2 pandemic. Impressions about teleneurology from patients and providers alike are generally favorable; some of the reported benefits include ease of access to specialized health care, savings of time and money, and similar quality of care as an in-person visit. However, comparisons between patient and provider impressions about the same teleneurology encounter have not been described. In this study, we describe patient impressions about a teleneurology encounter and evaluate concordance with provider impressions about the same encounter. Methods Patients and providers at the University of Pennsylvania Hospital Neurology Department were surveyed about their impressions of teleneurology between April 27, 2020, and June 16, 2020. A convenience sample of patients, whose providers completed a questionnaire, were contacted by telephone to solicit their impressions about the same encounter. Unique questionnaires for patients and providers focused on similar themes, such as adequacy of technology, assessment of history obtained, and overall quality of the visit. Summaries of patient responses are reported with the raw percent agreement between patients and providers for similar questions. Results One hundred thirty-seven patients completed the survey; 64 (47%) were male and 73 (53%) were female. Sixty-six (47%) patients had a primary diagnosis of PD, 42 (30%) a non-PD/parkinsonism movement disorder, and 29 (21%) a nonmovement disorder neurologic disease. One hundred one (76%) were established patient visits and 36 (26%) were new patient visits. Provider responses from 8 different physicians were included. Most of the patients responded that the ease of joining their visit, their comfort engaging with their physicians during their visit, understanding their plan of care after their visit, and the quality of care from their teleneurology visit were satisfactory. Patients and providers agreed about their impressions of the quality of the history obtained (87% agreement), patient-provider relationship (88% agreement), and overall quality of their experience (70% agreement). Discussion Patients had favorable impressions about their clinical experience with teleneurology and expressed an interest in incorporating telemedicine visits into their ongoing care. Patients and providers were highly concordant for the history obtained, patient-provider relationship, and overall quality.
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Affiliation(s)
- Justin G James
- Department of Neurology (JGJ, JP, AO, AS, MS, LRW, TFT), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; CW Psychological Services (JP), King of Prussia, PA; and Department of Biostatistics (SXX), Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jane Park
- Department of Neurology (JGJ, JP, AO, AS, MS, LRW, TFT), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; CW Psychological Services (JP), King of Prussia, PA; and Department of Biostatistics (SXX), Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alexandria Oliver
- Department of Neurology (JGJ, JP, AO, AS, MS, LRW, TFT), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; CW Psychological Services (JP), King of Prussia, PA; and Department of Biostatistics (SXX), Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Sharon X Xie
- Department of Neurology (JGJ, JP, AO, AS, MS, LRW, TFT), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; CW Psychological Services (JP), King of Prussia, PA; and Department of Biostatistics (SXX), Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Andrew Siderowf
- Department of Neurology (JGJ, JP, AO, AS, MS, LRW, TFT), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; CW Psychological Services (JP), King of Prussia, PA; and Department of Biostatistics (SXX), Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Meredith Spindler
- Department of Neurology (JGJ, JP, AO, AS, MS, LRW, TFT), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; CW Psychological Services (JP), King of Prussia, PA; and Department of Biostatistics (SXX), Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Lawrence R Wechsler
- Department of Neurology (JGJ, JP, AO, AS, MS, LRW, TFT), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; CW Psychological Services (JP), King of Prussia, PA; and Department of Biostatistics (SXX), Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Thomas F Tropea
- Department of Neurology (JGJ, JP, AO, AS, MS, LRW, TFT), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; CW Psychological Services (JP), King of Prussia, PA; and Department of Biostatistics (SXX), Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Vilendrer S, Saliba‐Gustafsson EA, Asch SM, Brown‐Johnson CG, Kling SM, Shaw JG, Winget M, Larson DB. Evaluating clinician‐led quality improvement initiatives: A system‐wide embedded research partnership at Stanford Medicine. Learn Health Syst 2022; 6:e10335. [PMID: 36263267 PMCID: PMC9576232 DOI: 10.1002/lrh2.10335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Many healthcare delivery systems have developed clinician‐led quality improvement (QI) initiatives but fewer have also developed in‐house evaluation units. Engagement between the two entities creates unique opportunities. Stanford Medicine funded a collaboration between their Improvement Capability Development Program (ICDP), which coordinates and incentivizes clinician‐led QI efforts, and the Evaluation Sciences Unit (ESU), a multidisciplinary group of embedded researchers with expertise in implementation and evaluation sciences. Aim To describe the ICDP‐ESU partnership and report key learnings from the first 2 y of operation September 2019 to August 2021. Methods Department‐level physician and operational QI leaders were offered an ESU consultation to workshop design, methods, and overall scope of their annual QI projects. A steering committee of high‐level stakeholders from operational, clinical, and research perspectives subsequently selected three projects for in‐depth partnered evaluation with the ESU based on evaluability, importance to the health system, and broader relevance. Selected project teams met regularly with the ESU to develop mixed methods evaluations informed by relevant implementation science frameworks, while aligning the evaluation approach with the clinical teams' QI goals. Results Sixty and 62 ICDP projects were initiated during the 2 cycles, respectively, across 18 departments, of which ESU consulted with 15 (83%). Within each annual cycle, evaluators made actionable, summative findings rapidly available to partners to inform ongoing improvement. Other reported benefits of the partnership included rapid adaptation to COVID‐19 needs, expanded clinician evaluation skills, external knowledge dissemination through scholarship, and health system‐wide knowledge exchange. Ongoing considerations for improving the collaboration included the need for multi‐year support to enable nimble response to dynamic health system needs and timely data access. Conclusion Presence of embedded evaluation partners in the enterprise‐wide QI program supported identification of analogous endeavors (eg, telemedicine adoption) and cross‐cutting lessons across QI efforts, clinician capacity building, and knowledge dissemination through scholarship.
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Affiliation(s)
- Stacie Vilendrer
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Erika A. Saliba‐Gustafsson
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Steven M. Asch
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Cati G. Brown‐Johnson
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Samantha M.R. Kling
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Jonathan G. Shaw
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Marcy Winget
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - David B. Larson
- Department of Radiology Stanford University School of Medicine California USA
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Jang Y, Moon J, Lee ST, Lee SK, Chu K. Telemedicine in epilepsy and encephalitis: previous research and indication guidelines in Korea. ENCEPHALITIS 2022; 2:65-72. [PMID: 37469460 PMCID: PMC10295915 DOI: 10.47936/encephalitis.2022.00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 04/28/2022] [Accepted: 05/18/2022] [Indexed: 07/21/2023] Open
Abstract
Telemedicine is an emerging field of medicine that has become more important during the coronavirus disease 2019 (COVID-19) pandemic era and is being studied actively in various medical fields. In neurology, the introduction of telemedicine is accelerating worldwide under the label of teleneurology. So far, few studies have been conducted on telemedicine for patients with epilepsy. In nonmetropolitan areas, video-based clinics have been demonstrated to be effective for seizure control, and smartphone-based diagnosis has also been confirmed to be accurate. Indeed, after the onset of the COVID-19 pandemic, telemedicine has been used to treat patients with epilepsy around the world. Few studies have examined the use of telemedicine for patients with autoimmune encephalitis. One showed that telephone-based evaluation is sufficient to assess the cognitive reserve of leucine-rich glioma inactivated-1-antibody encephalitis patients, thereby diagnosing their dementia. Telephone-based outpatient clinics are temporarily permitted under Korean medical law, and telemedicine can be attempted for clinically stable patients with epilepsy in Korea. In addition, patients with autoimmune encephalitis in stable or improving status may also be candidates for treatment with telemedicine. This review presents evidence for the safety and efficacy of telemedicine to treat epilepsy and encephalitis patients and discusses indication guidelines. Based on our literature review and current Korean medical law, we suggest tentative guidelines for telemedicine in the fields of epilepsy and autoimmune encephalitis.
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Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jangsup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Sasnal M, Miller-Kuhlmann R, Merrell SB, Beres S, Kipp L, Lee S, Threlkeld Z, Nassar AK, Gold CA. Feasibility and acceptability of virtually coaching residents on communication skills: a pilot study. BMC MEDICAL EDUCATION 2021; 21:513. [PMID: 34583691 PMCID: PMC8478605 DOI: 10.1186/s12909-021-02936-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Developing communication skills is a key competency for residents. Coaching, broadly accepted as a training modality in medical education, has been proven a successful tool for teaching communication skills. Little research is available thus far to investigate virtual coaching on communication skills for telemedicine encounters. The purpose of the study was to test the hypothesis that virtually coaching residents on communication skills is feasible and acceptable. We surveyed 21 resident-faculty pairs participating in a "fully virtual" coaching session (patient, coach, and resident were virtual). METHODS We asked 50 neurology resident-faculty coach pairs to complete one "fully virtual" coaching session between May 20 and August 31, 2020. After each session, the resident and coach completed a 15-item survey, including Likert-style scale and open-ended questions, assessing feasibility and acceptability. Descriptive statistics and qualitative content and thematic analyses were performed. RESULTS Forty-two percent (21/50) of all eligible residents completed "fully virtual" coaching sessions. The overall survey response rate was 91 % (38/42). The majority of respondents agreed that the direct observation and debriefing conversation were easy to schedule and occurred without technical difficulties and that debriefing elements (self-reflection, feedback, takeaways) were useful for residents. Ninety-five percent of respondents rated the coach's virtual presence to be not at all disruptive to the resident-patient interaction. Virtual coaching alleviated resident stress associated with observation and was perceived as an opportunity for immediate feedback and a unique approach for resident education that will persist into the future. CONCLUSIONS In this pilot study, residents and faculty coaches found virtual coaching on communication skills feasible and acceptable for telemedicine encounters. Many elements of our intervention may be adoptable by other residency programs. For example, residents may share their communication goals with clinic faculty supervisors and then invite them to directly observe virtual encounters what could facilitate targeted feedback related to the resident's goals. Moreover, virtual coaching on communication skills in both the in-person and telemedicine settings may particularly benefit residents in challenging encounters such as those with cognitively impaired patients or with surrogate decision-makers.
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Affiliation(s)
- Marzena Sasnal
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, 1070 Arastradero Rd, Stanford, CA, 94305, USA
| | - Rebecca Miller-Kuhlmann
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Sylvia Bereknyei Merrell
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, 1070 Arastradero Rd, Stanford, CA, 94305, USA
| | - Shannon Beres
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Lucas Kipp
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Sarah Lee
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Zachary Threlkeld
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Aussama K Nassar
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Carl A Gold
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA.
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