Rapid Cycle Quality Improvement of Telemedicine Protocols in a Skilled Nursing Facility During the COVID-19 Pandemic.

Prior to the COVID-19 pandemic, telemedicine was not well adopted in US nursing facilities. Many nursing facilities have since acknowledged its value due to the need for stricter infection control and reduction of exposure risk from face-to-face visits. A quality improvement project was conducted to improve telemedicine protocols in a high-volume post-acute care nursing facility, enhance provider and facility capability for visits, improve attitudes and skills toward telemedicine, and expand patient access to medical care during the pandemic. Process improvement was facilitated through identifying core areas of need and implementing interventions to address them. Project impact was measured by a retrospective pre-post survey of 7 questions to evaluate process improvement, attitudes, skills, and perceptions using a 5-point Likert scale (5=strongly agree, 1=strongly disagree) completed by 22 respondents (8 medical providers and 14 staff). Scores from before and after implementation were compared using paired t-tests. Respondents expressed improvement in perceived value (3.2 vs 4.8), personal skill/efficiency (2.3 vs 4.2), comfort level (2.3 vs 4.5), and scheduling process (2.3 vs 3.9) for telemedicine visits (all P≤.001). Respondents expressed increased awareness of barriers/benefits of telemedicine (2.8 vs 4.7, P<.001) and improved leadership commitment (2.6 vs 4.4, P<.001). The weekly average number of telemedicine visits per respondent increased significantly after protocol implementation (6.5 vs 25.6, P=.002). With support of facility leadership, interdisciplinary team members and engagement of key stakeholders, a telemedicine protocol was implemented in a single, high-volume, post-acute care skilled nursing facility during the COVID-19 pandemic, allowing patients to receive needed care.

Preventive Care and Outcomes of Interprofessional Medicare Annual Wellness Visits for Older Adults.

As we anticipate a growing population of older adults, we will see an increase in chronic conditions such as dementia and falls. To meet these public health needs, we must systematically provide screening, education, preventive care, and supportive care for older patients and their caregivers in a primary care setting. This will require a workforce trained in providing for the complex medical and psychosocial needs of an older adult population in an interprofessional and collaborative fashion. By integrating geriatric screening tools into an interdisciplinary Annual Wellness Visit teaching clinic, we were able to successfully improve rates of geriatric screening for dementia, depression, falls, medication reconciliation and advance care planning. We also saw improvements in patient care and satisfaction and provided the opportunity for interprofessional collaboration and education for students in medicine, nursing, pharmacy and social work.