Virtual Visits at Brigham and Women's Hospital

Stroke Clinical Trial

Official title:

Virtual Visits at Brigham and Women's Hospital: A Randomized Controlled Trial

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT03592355
• Other study ID #: 2018P000452
• Status: Terminated
• Phase: N/A
• Start date: April 13, 2018
• Est. completion date: March 1, 2020

Study information

• Verified date: September 2021
• Source: Brigham and Women's Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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.

Description:

If enrolled in the intervention arm, the following steps will occur: - The clinician will receive the intervention arm follow-up email ("Follow-up Email - Intervention" in the Appendix). - 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 (attached). If enrolled in the control arm, the following steps will occur: - The clinician will receive the control arm follow-up email ("Follow-up Email - Control" in the Appendix). - 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 (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.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 77
• Est. completion date: March 1, 2020
• Est. primary completion date: March 1, 2020
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Clinician whose department is chosen for virtual visit rollout

Exclusion Criteria:

• Clinician who saw on average fewer than 20 patients monthly over the past 6 months
• Clinician who opts out of virtual visits

Related Conditions & MeSH terms

• BPH
• Diabetes Mellitus
• Heart Failure
• Hyperlipidemia
• Hyperlipidemias
• Hypertension
• Stroke

Intervention

Other:
• Virtual Visit
Clinicians will have a synchronous video visit with their patients.

Locations

Country	Name	City	State
United States	Brigham and Women's Hospital	Boston	Massachusetts

Sponsors (1)

Lead Sponsor	Collaborator
Brigham and Women's Hospital

Country where clinical trial is conducted

United States, 

References & Publications (3)

Dorsey ER, Topol EJ. State of Telehealth. N Engl J Med. 2016 Jul 14;375(2):154-61. doi: 10.1056/NEJMra1601705. Review. — View Citation

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. — View Citation

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. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Days until third available appointment	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.	Through study completion, an average of 6 months
Secondary	Days until first available appointment	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.	Through study completion, an average of 6 months
Secondary	Future capacity: percentage of open appointment slots	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.	Through study completion, an average of 6 months
Secondary	Frequency of visits with the usual provider of care	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.	Through study completion, an average of 6 months
Secondary	Continuity of care index	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	Through study completion, an average of 6 months
Secondary	No show rate	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.	Through study completion, an average of 6 months
Secondary	Visit time	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.	Through study completion, an average of 6 months
Secondary	Clinician volume per hour	Patients seen per hour, calculated at the end of the study.	Through study completion, an average of 6 months
Secondary	Clinician volume per day	Patients seen per day, all calculated at the end of the study.	Through study completion, an average of 6 months
Secondary	Clinician volume per month	Patients seen per month, all calculated at the end of the study.	Through study completion, an average of 6 months
Secondary	Clinician volume per 6 months	Patients seen per 6 months, all calculated at the end of the study.	Through study completion, an average of 6 months
Secondary	Slot utilization	Ratio of used slots to total slots, obtained each week. The mean of all of the weeks is a clinician's slot utilization.	Through study completion, an average of 6 months
Secondary	Number of primary care visits	Number of primary care visits	Through study completion, an average of 6 months
Secondary	Number of specialist visits	Number of specialist visits	Through study completion, an average of 6 months
Secondary	Number of emergency department visits	Number of emergency department visits	Through study completion, an average of 6 months
Secondary	Number of inpatient admissions	Number of inpatient admissions	Through study completion, an average of 6 months
Secondary	Number of imaging studies	Number of imaging studies ordered	Through study completion, an average of 6 months
Secondary	Number of labs ordered	Number of laboratory studies ordered	Through study completion, an average of 6 months
Secondary	Number of medications prescribed	Number of medications prescribed	Through study completion, an average of 6 months
Secondary	Patient Experience	Brigham Health Virtual Care team survey sent to participating patients	Sent electronically within 1 week of the in-person or virtual visit
Secondary	Revenue from virtual or in-person visit	Revenue garnered by an individual clinician for her/his clinical activity, calculated per hour and per 6 months (denominator: total clinical hours worked).	Through study completion, an average of 6 months