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. 2021 Aug;12(4):933-943.
doi: 10.1055/s-0041-1735974. Epub 2021 Oct 6.

Consequences of Rapid Telehealth Expansion in Nursing Homes: Promise and Pitfalls

Kimberly R Powell  1 , Gregory L Alexander  2
Affiliations

Consequences of Rapid Telehealth Expansion in Nursing Homes: Promise and Pitfalls

Kimberly R Powell et al. Appl Clin Inform. 2021 Aug.

Abstract

Background: Expectations regarding use and potential benefits of telehealth (TH) in nursing homes (NHs) are high; however, unplanned and unexpected consequences can occur as a result of major policy and technological changes.

Objectives: The goal of this study was to elicit stakeholder perspectives of consequences of rapid TH expansion in NHs.

Methods: Using a qualitative descriptive design, we drew a sample based on findings from a national study examining trends in NH information and technology (IT) maturity, including TH use. We used maximum variation sampling to purposively select participants who (1) participated in our IT maturity survey for two consecutive years, (2) completed year 1 of the IT maturity survey prior to TH expansion (before March 6, 2020) and year 2 after TH expansion (after March 6, 2020), (3) represented a broad range of facility characteristics, and (4) were identified as an end user of TH or responsible for TH implementation. Using six questions from the IT maturity survey, we created a total TH score for each facility and selected participants representing a range of scores.

Results: Interviews were conducted with (n = 21) NH administrators and clinicians from 16 facilities. We found similarities and differences in perceptions of TH expansion according to facility TH score, NH location, and participant role. Desirable consequences included four subthemes as follows: (1) benefits of avoiding travel for the NH resident, (2) TH saving organizational resources, (3) improved access to care, and (4) enhanced communication. Undesirable consequences include the following five subthemes: (1) preference for in-person encounters, (2) worsening social isolation, (3) difficulty for residents with cognitive impairment, (4) workflow and tech usability challenges, and (5) increased burden on NH staff/infrastructure. Participants from rural NHs perceived lack of training, poor video/sound quality, and internet/connectivity issues to be potential pitfalls.

Conclusion: Clinicians and NH administrators should consider leveraging the desirable consequences of rapid TH expansion and implement mitigation strategies to address the undesirable/unanticipated consequences.

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Conflict of interest statement

G.L.A. and K.R.P. report grants from Agency for Healthcare Research and Quality during the conduct of the study.

Figures

Fig. 1
Fig. 1
Conceptual model of consequences of rapid telehealth expansion in nursing homes.
See this image and copyright information in PMC

References

    1. Office of the National Coordinatior for Health Information Technology Telemedicine and telehealthAccessed August 27, 2021 at:https://www.healthit.gov/topic/health-it-initiatives/telemedicine-and-te...
    1. Centers for Medicare and Mediciad Services Medicare telemedicine health care provider fact sheetAccessed May 17, 2021 at:https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-ca...
    1. U.S. Department of Health and Human Services Provider relief fund past paymentsAccessed May 20, 2021 at:https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/general-i...
    1. Office of Civil Rights Notification of enforcement discretion for telehealth remote communications during the COVID-19 nationwide public health emergencyAccessed May 17, 2021 at:https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-pre...
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