Maryland-based MedStar Health has received a nearly $2 million grant from the Agency for Healthcare Research and Quality (AHRQ) to expand its research with Stanford Medicine and Intermountain Healthcare focused on telehealth access, safety, and equity.
The grant will allow researchers to establish a patient safety learning laboratory over a four-year funding period to apply a cross-disciplinary, human factors and systems engineering approach to connected care enhancements, especially among patients with chronic conditions and other vulnerable populations. This award comes after npj Digital Medicine’s recent publication of the team’s study, “The impact of expanded telehealth availability on primary care utilization,” which resulted from research conducted under the initial grant award. The study found the unprecedented availability of telehealth during the pandemic did not lead to an increase in unnecessary primary care sessions.
“Our initial research demonstrates that telehealth is delivering on its promise to provide accessible and effective care,” said Raj Ratwani, Ph.D., co-principal investigator for both grants, vice president of scientific affairs for the MedStar Health Research Institute, and director of the MedStar Health National Center for Human Factors in Healthcare, in a statement. “Thanks to the continued support of AHRQ, we will advance patient safety nationally by studying and scaling telehealth as a proactive safety tool while also enhancing its safe use within the diverse communities served by connected care.”
For the team’s study, researchers analyzed more than 4.1 million completed in-person and telehealth (video or phone) adult primary care encounters for nearly 940,000 unique patients at MedStar Health, Stanford Health Care, and Intermountain Healthcare from Jan. 1, 2019 to Dec. 31, 2021, as well as each patient’s payer type (commercial, Medicaid, Medicare, and other). They determined the mean number of encounters for all these patients, as well as the subset who had at least one encounter every year. For both groups, the mean number of encounters showed little change from year to year, and those patients who had more than one encounter per year tended to use telehealth more than those with only one encounter per year.
“While we expected to see variability in telehealth use in primary care, we were interested to learn that those patients with chronic illness and frequent primary care needs consistently replaced one to two visits per year with a telehealth visit,” said Ethan Booker, M.D., study co-author, co-principal investigator for both grants, and chief medical officer of telehealth for MedStar Health. “This finding underscores our entry into a new era of chronic care, as telehealth helps providers increase access and care continuity for patients who need it most. Given the evidence that telehealth has expanded our care capabilities, we believe federal and state legislation and regulations should continue to protect telehealth access.”
Through the new grant, the team will continue work under the name Connected Care — Care Access, Research, Equity — and Safety Consortium and expand beyond their initial focus on primary care. They will study the care continuum tied to outpatient settings more holistically, with special attention to chronic care and health equity. To consider safety solution design, development, and implementation, they will also collaborate with experts at Microsoft Research and virtual care platform-as-a-service provider Bluestream Health, and with health equity and patient and family advisors. The co-principal investigators have identified four areas of possible impact to explore:
• Proactive opportunities to advance safety and health through telehealth are powerful. The team will study ways to reinforce/expand the safe use of telehealth, such as enhancing existing information transfer between standalone telehealth organizations and emergency departments. Importantly, they will also consider how to proactively use telehealth to improve safety, like when a provider may see and address a fall risk during a video visit.
• Process optimization remains as essential to safety as technology enhancements. The ability to communicate about and deliver on specialty care referrals following on-demand or scheduled telehealth visits, for example, is critical to the continuum of care and benefits from a human factors and systems engineering approach.
• Personalization of telehealth technology use serves as a key to both safety and health equity. Past research shows that the ability to safely deliver care via phone, video, and other unique telehealth technologies, like chatbots, is vital to serving vulnerable patients, people with disabilities, patients with diverse language needs, people with chronic conditions, and those who may need to use telehealth to evaluate if symptoms require care now or can wait.
• Provider well-being is an urgent priority for patient safety as care becomes more connected. Providers are reporting that patients’ use of portal messages for clinical questions has increased exponentially, for example. It is important to identify staffing and technology solutions to reduce any related after-hours provider workload for safety and well-being.
