Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec;70(12):3493-3502.
doi: 10.1111/jgs.18020. Epub 2022 Aug 30.

A mixed-methods analysis of telehealth implementation in nursing homes amidst the COVID-19 pandemic

Kimberly R Powell  1 , Amy E Winkler  1 , Jianfang Liu  2 , Gregory L Alexander  2
Affiliations

A mixed-methods analysis of telehealth implementation in nursing homes amidst the COVID-19 pandemic

Kimberly R Powell et al. J Am Geriatr Soc. 2022 Dec.

Abstract

Background: The COVID-19 pandemic has forced nursing homes to adapt new models of care in response to the evolving crisis including rapid implementation of telehealth services. The purpose of our study was to investigate implementation of telehealth in nursing homes amidst the COVID-19 pandemic using a human factors model.

Methods: Using a mixed methods design, we conducted a secondary analysis of data from a national survey of nursing home administrative leaders (n = 204). Using six survey questions, we calculated a total telehealth score (range 0-42). Descriptive statistics and paired sample t-test were used to explore the change in telehealth in two consecutive years (2019-2021). Next, we conducted semi-structured interviews with (n = 21) administrators and clinicians to assess differences in implementation according to extent of telehealth use.

Results: The mean telehealth score in year 1 was 12.11 (SD = 9.85) and year 2 was 19.25 (SD = 11.25). There was a significant difference in telehealth scores from year 1 to year 2 (t = 6.83, p < 0.000). While 64% of nursing homes reported higher telehealth scores in year 2 compared to year 1, over 32% reported a decline. Qualitative analysis revealed facilitators of telehealth including training, use of integrated equipment, having staff present for the visit, and using telehealth for different types of visits. Barriers included using smart phones to conduct the visit, billing, interoperability and staffing.

Conclusion: Training, adaptation of work processes to support communication, and restructuring teams and tasks are the result of interactions between system components that could improve usability and sustainability of telehealth in nursing homes.

Keywords: SEIPS model; human factors; informatics; nursing homes; telehealth.

PubMed Disclaimer

Conflict of interest statement

The authors have no personal conflicts to disclose.

Figures

FIGURE 1
FIGURE 1
Distribution of change in TH score from year 1 to year 2
See this image and copyright information in PMC

References

    1. World Heatlh Organization . WHO Coronavirus (COVID‐19) Dashboard. Accessed February 15, 2022. https://covid19.who.int/.
    1. Chidambaram Priya and Garfield Rachel. Nursing Homes Experience Steeper Increase in COVID‐19 Cases and Deaths in August 2021 than in the Rest of the Country. 2021. Accessed February 15, 2022. https://www.kff.org/coronavirus-covid-19/issue-brief/nursing-homes-exper....
    1. What is telehealth? NEJM catalyst. Accessed February 15, 2022. 10.1056/CAT.18.0268. - DOI
    1. Grabowski DC, O'Malley AJ. The care span: use of telemedicine can reduce hospitalizations of nursing home residents and generate savings for medicare. Health Aff. 2014;33(2):244‐250. doi: 10.1377/hlthaff.2013.0922 - DOI - PubMed
    1. Hui E, Woo J, Hjelm M, Zhang YT, Tsui HT. Telemedicine: a pilot study in nursing home residents. Gerontology. 2001;47(2):82‐87. doi: 10.1159/000052778 - DOI - PubMed

Publication types