Sinclair School of Nursing, University of Missouri, Columbia, Missouri, United States.
School of Nursing, Columbia University, New York, New York, United States.
Appl Clin Inform. 2021 Aug;12(4):933-943. doi: 10.1055/s-0041-1735974. Epub 2021 Oct 6.
Expectations regarding use and potential benefits of telehealth (TH) in nursing homes (NHs) are high; however, unplanned and unexpected consequences can occur as a result of major policy and technological changes.
The goal of this study was to elicit stakeholder perspectives of consequences of rapid TH expansion in NHs.
Using a qualitative descriptive design, we drew a sample based on findings from a national study examining trends in NH information and technology (IT) maturity, including TH use. We used maximum variation sampling to purposively select participants who (1) participated in our IT maturity survey for two consecutive years, (2) completed year 1 of the IT maturity survey prior to TH expansion (before March 6, 2020) and year 2 after TH expansion (after March 6, 2020), (3) represented a broad range of facility characteristics, and (4) were identified as an end user of TH or responsible for TH implementation. Using six questions from the IT maturity survey, we created a total TH score for each facility and selected participants representing a range of scores.
Interviews were conducted with ( = 21) NH administrators and clinicians from 16 facilities. We found similarities and differences in perceptions of TH expansion according to facility TH score, NH location, and participant role. Desirable consequences included four subthemes as follows: (1) benefits of avoiding travel for the NH resident, (2) TH saving organizational resources, (3) improved access to care, and (4) enhanced communication. Undesirable consequences include the following five subthemes: (1) preference for in-person encounters, (2) worsening social isolation, (3) difficulty for residents with cognitive impairment, (4) workflow and tech usability challenges, and (5) increased burden on NH staff/infrastructure. Participants from rural NHs perceived lack of training, poor video/sound quality, and internet/connectivity issues to be potential pitfalls.
Clinicians and NH administrators should consider leveraging the desirable consequences of rapid TH expansion and implement mitigation strategies to address the undesirable/unanticipated consequences.
人们对养老院中远程医疗（TH）的使用和潜在益处寄予厚望；然而，由于政策和技术的重大变革，可能会产生非计划和意外的后果。
本研究旨在了解利益相关者对养老院中 TH 快速扩张的后果的看法。
本研究采用定性描述设计，根据一项全国性研究的结果抽取样本，该研究考察了养老院信息和技术（IT）成熟度的趋势，包括 TH 的使用情况。我们采用最大差异抽样，有目的地选择了以下参与者：（1）连续两年参加我们的 IT 成熟度调查；（2）在 TH 扩张之前（2020 年 3 月 6 日之前）完成了 IT 成熟度调查的第一年，并且在 TH 扩张之后（2020 年 3 月 6 日之后）完成了第二年；（3）代表了广泛的设施特征；（4）被确定为 TH 的最终用户或负责 TH 的实施者。我们使用 IT 成熟度调查中的六个问题为每个设施创建了一个总的 TH 评分，并选择了代表不同评分范围的参与者。
我们对来自 16 家机构的 21 名 NH 管理员和临床医生进行了访谈。我们根据设施的 TH 评分、NH 所在地和参与者角色，发现了对 TH 扩张的看法的相似点和不同点。期望的结果包括以下四个子主题：（1）避免 NH 居民出行的好处；（2）TH 节省组织资源；（3）改善获得护理的机会；（4）增强沟通。不理想的后果包括以下五个子主题：（1）更喜欢面对面的交流；（2）加剧社会孤立；（3）认知障碍的居民难以适应；（4）工作流程和技术可用性挑战；（5）增加 NH 工作人员/基础设施的负担。来自农村 NH 的参与者认为培训不足、视频/声音质量差以及互联网/连接问题是潜在的问题。
临床医生和 NH 管理员应考虑利用 TH 快速扩张的理想结果，并实施缓解策略来应对不理想/意外的后果。
