Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access, Access, Provider Training/Education, Telehealth/Virtual Care

Intervention Description: The intervention in the study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City was the adoption and utilization of telehealth for prenatal care visits. The study aimed to evaluate the feasibility and effectiveness of telehealth for prenatal care during the COVID-19 pandemic, which necessitated a shift away from in-person visits to minimize the risk of viral transmission. The telehealth intervention involved the use of video conferencing technology to conduct prenatal care visits remotely. Patients were able to connect with their healthcare providers via video conferencing software, such as Zoom or Skype, to receive prenatal care services. The study analyzed the proportion of prenatal care visits that were conducted via telehealth compared to in-person visits over a 5-week period from March 9 to April 12, 2020, at Columbia University Irving Medical Center (CUIMC)-affiliated prenatal practices in New York City . The study also evaluated the challenges and successes associated with the adoption of telehealth for prenatal care, including provider attitudes towards telehealth, patient barriers to accessing telehealth, and operational considerations for clinics and healthcare systems . Overall, the intervention involved the rapid adoption and utilization of telehealth for prenatal care during the COVID-19 pandemic, with the aim of maintaining access to essential prenatal care services while minimizing the risk of viral transmission.

Intervention Results: The study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City found that telehealth was rapidly adopted and utilized for prenatal care during the study period. The study analyzed 4,248 prenatal care visits over a 5-week period, of which approximately one-third were conducted via telehealth (n=1,352, 31.8%). By the fifth week, 56.1% of generalist visits, 61.5% of maternal-fetal medicine (MFM) visits, and 41.5% of clinic visits were conducted via telehealth . The study also found that providers generally had positive attitudes towards telehealth visits, and accessing technology and performing visits, documentation, and follow-up using the telehealth electronic medical record were all viewed favorably by providers . However, the study identified significant barriers to telehealth and in-person visits, including patient fear of COVID-19 infection, limited access to technology and connectivity, and language barriers . The study also found that the transition to virtual prenatal care was more challenging for patients with Medicaid insurance receiving care at health clinics than for women with commercial insurance in generalist and maternal-fetal medicine faculty practices. Factors related to differential care attendance included operational considerations such as requiring increased staffing in clinics and patient factors related to technological proficiency, language barriers, Wi-Fi and data access, child care, and fear of infection. Additional patient-level and operational supports were required to optimize access for patients with Medicaid . Overall, the study suggests that telehealth was feasible and associated with provider satisfaction for prenatal care during the COVID-19 pandemic. However, significant barriers to telehealth may be present for patients with Medicaid insurance, which may require additional support to resolve .

Conclusion: The conclusions drawn from the study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City are as follows: 1. Rapid Transition Feasibility: The study demonstrated that a rapid transition to telehealth for prenatal care was feasible and associated with provider satisfaction. The adoption and utilization of telehealth for prenatal care were viewed favorably by healthcare providers . 2. Differential Uptake Based on Insurance: The study highlighted that telehealth uptake differed based on insurance, with patients with Medicaid insurance experiencing more challenges and barriers to accessing telehealth compared to those with commercial insurance. This finding underscores the need for additional patient-level and operational supports to optimize access for patients with Medicaid . 3. Operational Challenges: The transition to virtual prenatal care was more challenging for patients with Medicaid insurance receiving care at health clinics than for women with commercial insurance in generalist and maternal-fetal medicine faculty practices. Operational considerations, such as requiring increased staffing in clinics, were identified as significant barriers to the adoption of telehealth for prenatal care . 4. Patient Barriers: The study identified various patient-related barriers to telehealth, including technological proficiency, language barriers, Wi-Fi and data access, child care responsibilities, and fear of infection. These barriers need to be addressed to optimize access to telehealth for prenatal care, particularly for patients with Medicaid insurance . In summary, the study underscores the feasibility of rapid transition to telehealth for prenatal care and the need for additional support to address barriers faced by patients with Medicaid insurance. It emphasizes the importance of addressing operational challenges and patient-related barriers to ensure equitable access to telehealth for prenatal care during public health crises such as the COVID-19 pandemic .

Study Design: The study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City utilized a mixed-methods approach, combining quantitative analysis and qualitative assessment. Quantitative Analysis: The study analyzed trends in whether prenatal care visits were conducted in-person or via telehealth over a 5-week period from March 9 to April 12 at Columbia University Irving Medical Center (CUIMC)-affiliated prenatal practices in New York City during the COVID-19 pandemic. The proportion of visits that were conducted via telehealth was analyzed by visit type by week . This quantitative analysis provided insights into the adoption and utilization of telehealth for prenatal care during the specified period. Qualitative Assessment: In addition to the quantitative analysis, the study conducted a survey and semistructured interviews of healthcare providers to evaluate resources and obstacles in the uptake of telehealth. The survey and interviews aimed to understand provider experiences, satisfaction, and challenges associated with the integration of telehealth into prenatal care. The qualitative assessment provided in-depth insights into the operational challenges and barriers faced by healthcare providers and clinics during the transition to telehealth for prenatal care . By employing both quantitative and qualitative methods, the study aimed to comprehensively assess the transition to telehealth for prenatal care during the COVID-19 pandemic, providing a multifaceted understanding of the challenges, successes, and provider attitudes related to this transition.

Setting: The setting for the study on the transition of prenatal care to telehealth during the COVID-19 pandemic is New York City. Specifically, the study focuses on the prenatal care facilities affiliated with the Columbia University Irving Medical Center (CUIMC) located in midtown Manhattan, Washington Heights in Upper Manhattan, Rockland County, and Westchester . These facilities provide care for patients with both Medicaid and commercial insurance, and the patients accessing prenatal care at these sites primarily deliver at NewYork Presbyterian Morgan Stanley Children’s Hospital of New York and NewYork Presbyterian/The Allen Hospital . The study provides insights into the adoption of telehealth for obstetric patients in a tertiary referral hospital and clinic system in New York City, offering valuable information on the implementation of telehealth in an urban setting during the COVID-19 pandemic.

Population of Focus: The target audience for the study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City includes a wide range of stakeholders involved in maternal-fetal medicine, obstetrics and gynecology, public health, healthcare administration, and telehealth implementation. This may encompass: 1. Healthcare Providers: Obstetricians, gynecologists, maternal-fetal medicine specialists, and other healthcare professionals involved in prenatal care. 2. Healthcare Administrators: Hospital administrators, clinic managers, and healthcare system leaders responsible for implementing telehealth services and optimizing prenatal care delivery. 3. Public Health Officials: Professionals involved in public health policy, maternal and child health, and healthcare access initiatives. 4. Telehealth Practitioners: Individuals and organizations involved in the provision of telehealth services, including telemedicine companies and technology developers. 5. Researchers and Academics: Scholars and researchers interested in the impact of telehealth on prenatal care, healthcare delivery during crises, and healthcare disparities. 6. Policymakers: Government officials and policymakers involved in shaping healthcare regulations, reimbursement policies, and telehealth legislation. 7. Patient Advocacy Groups: Organizations advocating for improved access to prenatal care and maternal healthcare services. The study's findings are relevant to these stakeholders as they provide insights into the feasibility, challenges, and benefits of transitioning prenatal care to telehealth, particularly in an urban setting during a public health crisis. Additionally, the study's focus on provider attitudes and patient access issues makes it valuable for those interested in improving maternal healthcare delivery and access to early prenatal care.

Sample Size: Specifically, the study surveyed 36 healthcare providers and conducted interviews with 11 of them 8. While the exact sample size for the patient population is not provided, the study analyzed prenatal visits over a 5-week period from March 9, 2020, to April 12, 2020, during which time telehealth was adopted across clinical sites

Age Range: the study focused on prenatal care for pregnant individuals accessing care at the Columbia University Irving Medical Center (CUIMC)-affiliated obstetric ambulatory prenatal care facilities in New York City. As such, the patient population likely consisted of pregnant individuals of reproductive age, typically ranging from late teens to early 40s. Given the focus on prenatal care, the study's patient population would primarily include pregnant individuals seeking obstetric and gynecological care during the COVID-19 pandemic. The specific age range of these individuals was not explicitly stated in the available information.

Intervention Components (click on component to see a list of all articles that use that intervention): , Care Coordination, Telehealth/Virtual Care

Intervention Description: Medical advances have improved survival of critically ill children, increasing the number that have substantial ongoing care needs. The first aim of this study was to compare healthcare utilization of children with complex chronic conditions across an extensive geographic area managed by a predominantly telehealth-based team (FamiLy InteGrated Healthcare Transitions-FLIGHT) compared to matched historical controls. The second aim was to identify risk factors for healthcare utilization within the FLIGHT population. We performed a retrospective cohort study of all patients enrolled in the care management team. First, we compared them to age- and technology-based matched historic controls across medical resource-utilization outcomes. Second, we used univariable and multivariable linear regression models to identify risk factors for resource utilization within the FLIGHT population.

Intervention Results: Sixty-four FLIGHT patients were included, with 34 able to be matched with historic controls. FLIGHT patients had significantly fewer hospital days per year (13.6 vs. 30.3 days, p = 0.02) and shorter admissions (6.0 vs. 17.3 days, p = 0.02) compared to controls. Within the telehealth managed population, increased number of technologies was associated with more admissions per year (coefficient 0.90, CI 0.05 - 1.75) and hospital days per year (16.83, CI 1.76 - 31.90), although increased number of complex chronic conditions was not associated with an increase in utilization.

Conclusion: A telehealth-based care coordination team was able to significantly decrease some metrics of healthcare utilization in a complex pediatric population. Future study is warranted into utilization of telemedicine for care coordination programs caring for children with medical complexity.

Intervention Components (click on component to see a list of all articles that use that intervention): Organizational Changes, Prenatal Care Access, Access, Telehealth/Virtual Care

Intervention Description: The OB Nest intervention involved a reduced-frequency prenatal care model enhanced with remote home monitoring devices and nursing support. Participants in the OB Nest group received 8 scheduled clinic appointments with an obstetrician or a certified nurse midwife, as well as 6 virtual (phone or online) connected care visits with an OB Nest registered nurse. These virtual visits consisted of home blood pressure and fetal heart rate evaluation. Additionally, the OB Nest model included home monitoring devices and an online prenatal community to support the pregnant women .

Intervention Results: The study found that participants in the OB Nest group had significantly higher satisfaction with care and lower prenatal-related stress compared to patients in the usual care group. Perceived quality of care was similar between groups. Adherence to the provision of American College of Obstetricians and Gynecologists prenatal services was similar in both arms. Maternal and fetal clinical outcomes were similar between groups. Total reported nursing time was higher in OB Nest. The study concluded that OB Nest is an innovative, acceptable, and effective reduced-frequency prenatal care model that resulted in higher patient satisfaction and lower prenatal stress while reducing the number of appointments with clinicians and maintaining care standards for pregnant women .

Conclusion: The study concluded that the OB Nest intervention is an innovative, acceptable, and effective reduced-frequency prenatal care model. It resulted in higher patient satisfaction and lower prenatal stress, while reducing the number of appointments with clinicians and maintaining care standards for pregnant women. The findings suggest that OB Nest is a step toward evidence-driven prenatal care that improves patient satisfaction .

Study Design: The study utilized a rigorous randomized controlled trial (RCT) design to compare the OB Nest prenatal care model with usual care. Participants were randomized to either OB Nest or usual care using a dynamic allocation system, with an algorithm minimizing imbalances in a 1:1 ratio across specific factors such as age, body mass index, and parity. The allocation sequence was concealed from the study nurse who enrolled and assessed the eligibility of participants. The study team nurses and clinicians were aware of the assigned arms after randomization occurred, and team members analyzing quantitative data were blinded to which intervention arm mothers were assigned to

Setting: The study was conducted as a single-center randomized controlled trial within the Outpatient Obstetric Division at Mayo Clinic, a tertiary care academic center in Rochester, Minnesota. The Mayo Clinic serves approximately 2400 pregnant women annually, and the trial took place between March 2014 and January 2015

Population of Focus: The target audience for the OB Nest prenatal care model and the study evaluating its effectiveness were low-risk pregnant women who were between 18 and 36 years old, at less than 13 weeks of gestation, and without a concurrent medical or obstetric complication, who had the ability to provide informed consent. The study aimed to evaluate the acceptability and effectiveness of the OB Nest model compared to traditional prenatal care for this specific population .

Sample Size: he study aimed to recruit 300 pregnant women, with 150 participants assigned to the OB Nest group and 150 participants assigned to the usual care group. The sample size was determined based on the power to detect differences in patient satisfaction, which was considered the most important endpoint for pregnant patients and caregiver representatives when creating the OB Nest bundle. The study was powered to detect differences in patient satisfaction with a 98% power to detect a difference of 7 points, based on a standard deviation of 14.4, with 10% attrition

Age Range: The study enrolled English-speaking pregnant women between 18 and 36 years old who were at less than 13 weeks of gestation. This age range was part of the enrollment criteria for the study .

Intervention Components (click on component to see a list of all articles that use that intervention): Telehealth, Technology-Based Support,

Intervention Description: The COVID-19 pandemic has led to unprecedented use of telehealth, including by primary care professionals (PCPs) who serve adolescents. To inform future practice and policies, we sought to characterize PCPs' recent experience using adolescent telehealth as well as their support for it after the COVID-19 pandemic is over.

Intervention Results: Most PCPs reported using telehealth for a low, moderate, or high proportion of their adolescent patients in the three months prior to the survey (424/1047, 40%, 286/1047, 27%, and 219/1047, 21%, respectively); only 11% (118/1047) reported no use. A majority of respondents agreed that adolescent telehealth increases access to care (720/1047, 69%) and enables them to provide high-quality care (560/1047, 53%). Few believed that adolescent telehealth takes too much time (142/1047, 14%) or encourages health care overuse (157/1047, 15%). Most supported giving families the option of adolescent telehealth for primary care after the pandemic is over (683/1047, 65%) and believed that health insurance plans should continue to reimburse for telehealth visits (863/1047, 82%). Approximately two-thirds (702/1047, 67%) wanted to offer adolescent telehealth visits after the pandemic, with intentions being higher among those with recent telehealth experience (P<.001).

Conclusion: PCPs in our national sample reported widespread use of and predominantly positive attitudes toward adolescent telehealth. Our findings also suggest broad support among PCPs for continuing to offer adolescent telehealth after the COVID-19 pandemic ends.

Study Design: Cross-sectional survey

Setting: Pediatric primary care practices across the US

Population of Focus: Primary care providers including physicians, advanced practitioners (ie, nurse practitioners and physician assistants), and nurses who provided primary care, including vaccinations, to adolescents aged 11-17 years

Sample Size: 1047 respondents comprised of physicians (n=747, 71%), advanced practitioners (n=177, 17%), and nurses (n=123, 12%)

Age Range: Primary care providers serving youth ages 11-17 years

Intervention Components (click on component to see a list of all articles that use that intervention): Outreach (Provider), Continuity of Care (Caseload), Notification/Information Materials (Online Resources, Information Guide), HEALTH_CARE_PROVIDER_PRACTICE, PARENT_FAMILY, Telehealth

Intervention Description: The purpose of this project was to determine the feasibility and effectiveness of videoconference handoffs between inpatient, case management, and home care nurses, and the patients/families during transitions of care from hospital to home care.

Intervention Results: Videoconference handoffs (n = 10) were found to be feasible and address gaps in communication, coordination of care, and patient/family engagement during transitions from hospital to home care.

Conclusion: Postpilot, nurses agreed the videoconference handoffs should continue with minimal modifications.