Virtual Visits at Brigham and Women's Hospital
Study Details
Study Description
Brief Summary
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.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
If enrolled in the intervention arm, the following steps will occur:
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The clinician will receive the intervention arm follow-up email ("Follow-up Email - Intervention" in the Appendix).
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The Brigham Health Virtual Care team will work with the clinician toward immediate on-boarding (software training, hardware setup, technical support) as per their usual process.
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The clinician will schedule virtual visits as s/he and/or her/his department see fit. Virtual visits occur on an already-in-use Partners- and Brigham-approved video platform (attached).
If enrolled in the control arm, the following steps will occur:
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The clinician will receive the control arm follow-up email ("Follow-up Email - Control" in the Appendix).
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Three months from the time of the follow-up email, the Brigham Health Virtual Care team will work with the clinician toward immediate on-boarding (software training, hardware setup, technical support) as per their usual process.
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The clinician will schedule virtual visits as s/he and/or her/his department see fit. Virtual visits occur on an already-in-use Partners- and Brigham-approved video platform (attached).
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.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Intervention If enrolled in the intervention arm, the following steps will occur: The Brigham Health Virtual Care team will work with the clinician toward immediate on-boarding (software training, hardware setup, technical support) as per their usual process. The clinician will schedule virtual visits as s/he and/or her/his department see fit. Virtual visits occur on an already-in-use Partners- and Brigham-approved video platform. |
Other: Virtual Visit
Clinicians will have a synchronous video visit with their patients.
|
| No Intervention: Control If enrolled in the control arm, the following steps will occur: Three months from the time of the follow-up email, the Brigham Health Virtual Care team will work with the clinician toward immediate on-boarding (software training, hardware setup, technical support) as per their usual process. The clinician will schedule virtual visits as s/he and/or her/his department see fit. Virtual visits occur on an already-in-use Partners- and Brigham-approved video platform. |
Outcome Measures
Primary Outcome Measures
- Days until third available appointment [Through study completion, an average of 6 months]
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.
Secondary Outcome Measures
- Days until first available appointment [Through study completion, an average of 6 months]
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.
- Future capacity: percentage of open appointment slots [Through study completion, an average of 6 months]
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.
- Frequency of visits with the usual provider of care [Through study completion, an average of 6 months]
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.
- Continuity of care index [Through study completion, an average of 6 months]
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
- No show rate [Through study completion, an average of 6 months]
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.
- Visit time [Through study completion, an average of 6 months]
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.
- Clinician volume per hour [Through study completion, an average of 6 months]
Patients seen per hour, calculated at the end of the study.
- Clinician volume per day [Through study completion, an average of 6 months]
Patients seen per day, all calculated at the end of the study.
- Clinician volume per month [Through study completion, an average of 6 months]
Patients seen per month, all calculated at the end of the study.
- Clinician volume per 6 months [Through study completion, an average of 6 months]
Patients seen per 6 months, all calculated at the end of the study.
- Slot utilization [Through study completion, an average of 6 months]
Ratio of used slots to total slots, obtained each week. The mean of all of the weeks is a clinician's slot utilization.
- Number of primary care visits [Through study completion, an average of 6 months]
Number of primary care visits
- Number of specialist visits [Through study completion, an average of 6 months]
Number of specialist visits
- Number of emergency department visits [Through study completion, an average of 6 months]
Number of emergency department visits
- Number of inpatient admissions [Through study completion, an average of 6 months]
Number of inpatient admissions
- Number of imaging studies [Through study completion, an average of 6 months]
Number of imaging studies ordered
- Number of labs ordered [Through study completion, an average of 6 months]
Number of laboratory studies ordered
- Number of medications prescribed [Through study completion, an average of 6 months]
Number of medications prescribed
- Patient Experience [Sent electronically within 1 week of the in-person or virtual visit]
Brigham Health Virtual Care team survey sent to participating patients
- Revenue from virtual or in-person visit [Through study completion, an average of 6 months]
Revenue garnered by an individual clinician for her/his clinical activity, calculated per hour and per 6 months (denominator: total clinical hours worked).
Eligibility Criteria
Criteria
Inclusion Criteria:
- Clinician whose department is chosen for virtual visit rollout
Exclusion Criteria:
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Clinician who saw on average fewer than 20 patients monthly over the past 6 months
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Clinician who opts out of virtual visits
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Brigham and Women's Hospital | Boston | Massachusetts | United States | 02115 |
Sponsors and Collaborators
- Brigham and Women's Hospital
Investigators
- Principal Investigator: David Levine, MD, MPH, MA, Principal Investigator
Study Documents (Full-Text)
None provided.More Information
Publications
- Dorsey ER, Topol EJ. State of Telehealth. N Engl J Med. 2016 Jul 14;375(2):154-61. doi: 10.1056/NEJMra1601705. Review.
- 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. Review.
- 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. Review.
- 2018P000452