119 A comprehensive, adaptive approach to effective telehealth in a pediatric CF clinic

ABSTRACT

Background: At the onset of the 2020 COVID-19 pandemic, the VCU pediatric CF program decided to adapt our in-person model of clinical care to accommodate a new virtual environment for all routine CF clinic visits. Methods: With QI support from the Cystic Fibrosis Learning Network and our health system, we adapted to a new virtual model by testing and adopting strategies to promote a number of changes. 1) Optimal use of telehealth technology We utilized Zoom-based clinics with a virtual check- in waiting room, patient breakout rooms, and team room for ongoing communication during clinic. 2) Pre-visit planning and coproduction We sent pre-clinic messages to patients/families to solicit input on visit agenda and incorporated responses into virtual pre-clinic meetings;our pre-clinic message was revised to remind families of home health data to collect in preparation for visit. 3) Communication among team members and with patients/families We improved team communication with the addition of post-clinic meetings, including live joint editing of individual post-visit summaries that we email to each patient/family after team meeting. 4) Telehealth visit optimization and readiness Center discretionary funds were used to supplement CFF support to purchase ZephyRx spirometers for all patients >5yo, as well as home scales and tape measures for families in need of assistance. We arranged with microbiology to acquire and mail airway culture swabs with prepaid return packaging to patient homes. Various team members provided ongoing training and support in the use of these items. 5) Data tracking A tracking spreadsheet and run charts were created to track implementation of process measures (team member encounters, acquisition of PFTs, weights, heights, airway cultures), reviewed weekly by care team and our family partners. Results: Pre-COVID, all routine clinic visits were in person;from March 2020 to March 2021, 93% of routine visits were virtual. The impact of this change to virtual visits on our metrics was negligible (Table 1). We were able to provide home spirometers to 100% of age-eligible patients, home throat swab kits to 67%, and weight scales to 100% of patients who indicated need. Patient feedback also has been positive. Responses to our center-specific telehealth satisfaction survey indicate that patients consider telehealth visits to be as effective as in-person visits, would prefer for most visits to continue to be virtual, and find virtual visits to be efficient, convenient, and accessible. (Table presented.) Conclusion: Participation in routine CF clinic visits was not significantly hindered by switching to a virtual model. We can equip patients with the tools they need to collect important health data from home and can provide virtual support. Effective coproduction and collaborative agenda setting can occur virtually. Patients/families approve of, and may prefer, a virtual model.