2018 Poster Abstract
1. Expanding Health Care Provider Capacity to Treat Mental Health Disorders via Interactive Tele-Education
Background: At least one-in-five patient visits to primary care has a mental health component. Meanwhile, health care providers report a lack of resources and confidence in treating conditions such as depression, anxiety, sleep disorders, and addiction. Project ECHO® offers the potential to reduce these disparities for health care providers of all levels by promoting lifelong learning through the use of tele-education and guided practice.
Methods: Behavioral Health ECHO at The University of Utah was created with the following objectives: (1) to provide a collaborative setting for providers throughout the Intermountain West to discuss mental health treatments; (2) to disseminate best-practice guidelines for treatment; (3) to catalogue resources for providers; and (4) to provide a forum for case-based learning. The sessions were held on a weekly basis, attendance was recorded, and provider-level surveys measured change in knowledge and confidence level in treating various mental health disorders.
Results: There were 31 sessions held between October 2017 and June 2018, with a total of 104 unique attendees. Twelve patient cases were presented including diagnoses of MDD, schizophrenia, dementia, insomnia, etc. Provider-level surveys (n=35) demonstrated a 41% increase in knowledge of mental health diagnoses and treatment and a 32% increase in comfort level with treating mental health disorders. “Module 2: Mood Disorders” resulted in the biggest increase in provider knowledge (78%) and confidence level (50%). Participants self-reported that they plan to use scales and checklists more frequently in their practice and that they intend to be more collaborative when making treatment decisions.
Conclusions: Behavioral Health ECHO is an effective means of bringing providers together to discuss best-practices for diagnosing and treating mental health disorders. It has shown to increase provider knowledge and confidence in treating patients with mental health disorders and has encouraged implementation of best-practice guidelines.
Christina Choate, B.S
Program Coordinator, Project ECHO®
The University of Utah Health, Office of Network Development & Telehealth
2. Needs Assessment for Access to Healthcare in the Deaf Community
Background: In the United States, there are an estimated 26.9 million Deaf and hard of hearing individuals. This vulnerable population has been identified as being at risk for marginalization of healthcare due to communication challenges. Specific to the Deaf population, little is known about their ability to access and receive healthcare services via Telehealth and Video Remote Interpreting based on residence geographical location. What is not known based on a literature review is whether the Deaf population experiences barriers to their ability to access healthcare, what technology Deaf patients utilize when they consider accessing healthcare, what resources are provided by healthcare facilities to improve Deaf patient access, and what safety concerns the Deaf community has when seeking care.
Methods: The needs assessment survey will be sent through Qualtrics to each states’ respective Deaf council to distribute to their states’ Deaf members. This needs assessment will not have randomization, a control group, or an intervention. Consent will be obtained from the state prior to their inclusion of being sent the survey. The survey will contain definition of implied consent by participating and detailed information on the use and protection of gathered information. Data will be assessed by SPSS version 25.
Results: Data currently being collected with preliminary results anticipated by October.
Conclusions: Currently, state Deaf Councils believe more Deaf would have responded if questions had been signed by medical interpreters and imbedded into survey; it was not possible to do that for this survey due to lack of time for cross-validation of languages. Anticipated outcomes: Deaf respondents will be able to identify and define barriers, including technological, experienced when accessing healthcare; a relationship between use of technology and access to healthcare should be established; information gathered will be analyzed to identify any geographical correlations between urban and rural residing Deaf residents.
Sarah E. Curtright, DNPs, FNP-Ed, CLNC
Performance Improvement Coordinator
Old Dominion University
3. Reliability of Teletherapy as a Service Delivery Model for School Based Occupational Therapy
Background: Rural healthcare lacks the availability of healthcare services, lack of skilled providers, and socioeconomic status is a factor to pay for these services. In rural school systems, students who qualify for services may have limited or no access to specialists, and families may not have funds to travel the distance to the specialist to receive care. These barriers prevent families and their children from beneficial treatments and interventions they need, to maximize their participation in daily living and success in school, especially in rural states. Is teletherapy a reliable occupational therapy service delivery model to increase functional ability and outcomes in school-aged children?
Methods: Search terms were developed by researchers and implemented. The articles identified using the specific search terms were then subject to inclusion and exclusion criteria.
Results: Based on the inclusion and exclusion criteria, 5 articles were approved. Due to recent technology advances, this delivery model is new and minimal research has been done on the model, hence the limited number of articles identified. In all the studies, researchers found that all measured outcomes were increased. Functionally, fine motor and gross motor abilities, and even participation in daily activities demonstrated a significant increase. Using this technology to provide additional caregiver training, increased caregiver confidence in caring for these children.
Conclusion: The findings in these studies indicate that this delivery model can be utilized successfully within the OT scope of practice for clinical and community-based practice of occupational therapy.
Kathleen DeLapp-Cohn, MS, CCC-SLP
Rock Creek Therapy, LLC
4. Unique TeleICU Model Improves Rural Critical Care
Background: The University of Utah Health (UUH) TeleICU model was created in response to the unique needs of rural and frontier hospitals in the Intermountain West. Our model was designed to increase the capacity of rural and frontier hospitals to care for critically ill patients. Our non-traditional approach allowed for cost reduction related to the set-up and continuous monitoring of infrequently utilized ICU beds, and minimize low acuity transfers.
Methods: The UUH consultation-driven model focuses on acute patient care and building the clinical capacity of partner sites. This was accomplished through: 1) Clinical support provided by board certified intensivists for acute consultation. 2) A continuously staffed nursing support line makes available, in real-time, a nursing peer. 3) Didactic education offered through weekly online lectures and hands on training for nurses and affiliated staff at the UUH. 4) An analysis of current resources and capabilities using the UUH Critical Care Capacity Index (3CI) helps identify the clinical capacity for managing critically ill patients and identifies unique growth opportunities for each facility.
Results: Growth was measured by enrollment of partner sites, their increased ability to care for critically ill patients and a reduction in low acuity transfers. Since inception in 2015, we have added 10 partner sites and fielded 216 patient consultations. Capacity building is monitored by tracking hospital capability according to the 3CI, and by partner site reports of consult patients they have retained with TeleICU support. Our first partner site reported that in one year, they retained 25 patients that would have otherwise been transferred. Low acuity transfers to our facility that were discharged within 48 hrs were decreased 77% and 70% from the 2 TeleICU sites where data was available.
Conclusions: Based on our experience the evidence is in favor of a consultative model. We have been successful in increasing the clinical capacity of our partner sites and reducing low acuity transfers. This has translated into more patients staying in their communities and local facilities for critical care services. This program has aided UUH to ensure that scare specialty beds and providers are made available to the most critically ill patients across the region.
Jennifer Colarusso, BSN, RN, CCRN-K
TeleICU Program Coordinator
The University of Utah
5. Managing Surge Census with Pediatric TeleHealth Monitoring and Support
Background: Pediatric Critical Care Services (PCCS) at Primary Children's Hospital consists of 2 units, a 28 bed Pediatric Intensive Care Unit (PICU) and a 16 bed Cardiac Intensive Care Unit (CICU). Approximately 172 full time, part time and “as needed” staff provide baseline coverage of 25 registered nurses (RNs) per shift. During winter seasons, staffing needs surge to 35 to 40 RNs per shift, frequently employing float and travel RNs to close this coverage gap. The goal of the PCCS staff is safe, quality care for every child in their unit. Providing this care to complex patients requires a high degree of concentration supported by knowledge and skills. PCCS leadership appreciated the hands-on help provided by traveler and floater RNs, but were concerned about the number of interruptions to their experienced PICU staff.
Methods: PCCS TeleHealth program was implemented in January of 2017. Experienced PCCS RNs actively monitor patients and support nurses providing direct patient care. The TeleHealth RN focuses on patients assigned to traveler, float, and newly trained PCCS RNs as well as higher acuity patients. TeleHealth program protocols and measures adopted from the adult program and were modified for pediatric patients.
Results: Since inception, PCCS TeleHealth RNs have had over 33,000 TeleHealth interactions. Predefined categories of nursing intervention have been described. Video rounding is the most documented activity.
Conclusion: Experienced RNs can educate and coach bedside staff in Pediatric Critical Care units using telehealth technologies. Patient safety is enhanced when patient and staff have additional subject matter experts available for consultation and questions. Sick call and absenteeism are reduced when staff have experienced critical care RNs as a backup resource. Providing telehealth services within the unit setting increases the likelihood of the telehealth RN getting asked to assist on the unit.
Jordan Albritton, PhD, MPH
Sr. Statistical Data Analyst
Laura Carter, MSN, RN
Intermountain – Primary Children’s Hospital
Michelle L. Halgren, MHA
Intermountain Healthcare, Telehealth Pediatrics
Becky Lowe, BSN, RN
Pediatric TeleCritical Care Expanded Role RN
Primary Children's Hospital
Lory J. Maddox, MSN, MBA, RN
Clinical Manager, Connect Care Pro: Pediatrics
6. Leveraging the Power and Connections of Telehealth to Support Family Caregivers
Background: Approximately 43.5 million Americans provide close to 20 billion hours of unpaid financial, medical, social, and instrumental support to chronically ill and disabled family members. These substantial contributions often come at a cost to the family caregivers’ personal health and well-being, as many report feeling unprepared, unsupported, and strained by the caregiving role. The annual economic value of unpaid family-provided care is estimated at $232 billion, a cost savings to the healthcare system that is nontrivial. There exist many interventions to support family caregivers, most of which have relied on high levels of staff involvement to achieve fidelity and effect (i.e., support groups). Clinical providers may simply lack time and resources to provide this type of support and training to the family members. Furthermore, caregiver support is a non-reimbursable service and not usually a priority for traditional patient-oriented providers. This is even more emphasized in rural areas, where access to existing support programs is challenging and coordinated services may be lacking altogether. A potential solution to this problem is presented in telehealth, defined as the use of telecommunications technologies to support the delivery of remote clinical care. While telehealth has become increasingly and successfully used to deliver patient-oriented care, there has been little coordination of telehealth services to support the family caregivers.
Method/Results: We will review the types of online and self-administered caregiver support programs that are available and explore the ways in which clinical providers can leverage telehealth resources and telehealth networks to provide effective, yet cost-efficient, support programs for caregivers.
Conclusion: By discovering and sharing the capabilities, connections, and existing efforts of individual health care providers within the NRTRC network, we believe we are in the position to begin creating and implementing a shared and sustainable solution for delivering supportive services to family caregivers in rural areas.
Rebecca Utz, PhD
Associate Professor, Sociology & Gerontology
University of Utah
7. Telegenetics: Increasing Access to Genetic Counseling Services across the Intermountain West
Background: In an era of personalized medicine and direct-to-consumer genetic testing, there is an obvious and growing demand for genetic service providers. As trained specialists, genetic counselors are uniquely positioned to address these demands in healthcare. A national shortage of genetic counselors has highlighted telegenetics as an attractive tool to improve access to care. While independent companies that offer genetic counseling via telegenetics are working to meet this growing need; partnering with a local hospital can be especially useful to ensure the long-term care of high-risk patients and their families. This partnership can introduce exceptional alignment across healthcare systems and offer unique opportunities for engagement both clinically and in research.
Methods: The purpose of this review is to discuss the key components required to launch a telegenetics service line in partnership with a hospital system, and to share successes and challenges in starting and expanding a multi-site oncology telegenetics program.
Results: Since 2016, over 400 people across the Intermountain West have been referred for oncology genetic counseling services through contracts set up with Huntsman Cancer Institute in Salt Lake City, UT. Over half were seen via telegenetics (telephone or video). A major barrier to scheduling appointments included delays in site contracts leading to patients on hold being lost to follow-up.
Conclusions: Much of the demand for genetic counseling can arguably be met with telegenetics services. Launching this service in partnership with a local hospital system can help increase patient volumes and appropriate referrals over time. Streamline development of process flows and contracts are necessary to sustain momentum and engagement of patients and providers. Future directions include achieving more frequent engagement with providers at the originating site in order to improve services rendered and ensure appropriate follow-up of high risk patients.
Marjan Champine, MS, MBA, LCGC
Associate Clinical Director
Huntsman Cancer Institute
8. Improving Care for Children with Developmental Disabilities Using Telehealth
Background: Families of children with developmental disabilities (DD) living in rural areas have poor access to specialized care. Telehealth (TH) offers the potential to provide care for children with DD for visits not requiring in- person examination. Objective: (1) Evaluate the effect of process changes within a TH program for children with DD on the proportion of children from rural areas seen for TH visits by providers within a multidisciplinary child development clinic; (2) describe patient, family, and provider characteristics of TH visits; (3) compare reimbursement between TH visits and similar in- person visits and (4) assess family perceptions after participation in TH visits.
Design/Methods: Two types of TH visits began in April 2016, one for psychologists to provide diagnostic summaries after in-person evaluations and another with pediatricians for follow-up visits. Process changes included adoption of new TH software and enhanced TH care coordination. Monthly proportion of TH visits for families living in rural areas was assessed using P-charts from statistical process control methodology. We obtained patient and family characteristics by chart review of TH visits and we compared reimbursement rates between TH visits and similar in- person visits. Family perception of TH visits was assessed with a post visit survey.
Results: The combination of a new TH software and TH care coordination was associated with an increase in the proportion of completed TH visits in children from rural areas. Of 249 TH visits, the majority involved children with autism spectrum disorder (56%) and 81% were with families living in rural/frontier counties. Within pediatrician visits, psychotropic medication management was common (47%), with anxiety the most common condition treated (47%). The reimbursement rate was similar between TH and in-person visits (41% versus 40%). Among the 33% of families who completed a post visit survey, the majority were seen at home (83%), felt it was "very easy" to see (83%) and hear (63%) the provider, and "strongly agreed" that TH saved time (86%) and money (80%). Most felt the care delivered in TH visits was the same compared to in-person visits (75%).
Conclusion(s): New TH software and TH care coordination were associated with an increase in the proportion of children with DD from rural areas seen for TH visits by providers within a multidisciplinary child development clinic. TH visits were similarly reimbursed compared with in-person visits and were well received by families.
Laurie Lesher RN, MBA
Director of Operations, University Developmental Assessment Clinics
University Developmental Assessment Clinics
9. Telehealth, the New Service Delivery Model for Children and Families: Providing Occupational Therapy Through Technology
Background: We believe that it is essential for occupational therapy educational programs to examine the use of telehealth as a method for providing occupational therapy services to prepare students for the future of health care. By providing applied learning opportunities, students have an opportunity to experience the provision of telehealth services in preparation for the demands and expectations of working in tomorrow’s contemporary occupational therapy practice settings. The Salt Lake Community College has implemented three semesters of telehealth training for students in the two-year Associate of Applied Science Occupational Therapy Assistant Program. Faculty serve as mentors and supervisors as student implement interventions under their direction. This poster focuses on telehealth intervention focused on children and families.
Methods: A new model for telehealth service delivery for pediatric occupational therapy is introduced. Data-driven decision-making is applied as the research method. Quality indicators and outcomes for student learning are being measured by the department, as well as client satisfaction and goal completion. Results: Preliminary findings support that occupational therapy through the use of telehealth offers a successful way to provide health care in pediatric occupational therapy.
Conclusions: Telehealth is part of health care’s future by offering an alternative method to traditional service delivery especially for clients who are homebound, geographically remote, or who require specialization.
Brenda K. Lyman, OTD, OTR/L
Division of Allied Health, Division of Health Professions, School of Health Sciences, Salt Lake Community College
Robyn Thompson, PhD, OTR/L
Assistant Professor and Program Director
Salt Lake Community College
10. Telehealth Services at the Salt Lake Community College
Background: The Salt Lake Community College (SLCC) values community-based, experiential learning. The occupational therapy assistant program at SLCC has embraced these values, and provides a student-based pro bono occupational therapy clinic for adult and pediatric members of the community. In the fall of 2016, the occupational therapy assistant program expanded their clinic to include telehealth occupational therapy services for adult and pediatric clients who live in rural areas, or who are home bound and cannot access traditional out-patient services. These clients may also be underserved, uninsured or underinsured in relation to therapy services. The pro bono occupational therapy telehealth clinic at Salt Lake Community College utilizes synchronous video conferencing over a secure electronic platform to provide various types of therapy services including evaluation, treatment intervention, consultation, and parent and caregiver education and training. This poster and discussion by presenters will highlight thepragmatics of setting up a telehealth clinic, and establishing astudent-to-student mentoring model for providing occupational therapyservices.
Method: The presenters will share a process for collecting on-going outcome data, and adjusting treatment services based on that data. Results: Preliminary data that suggests pro bono occupational therapy services delivered by occupational therapy assistant students via telehealth is effective.
Conclusions: The presenters will reveal outcome data relatedto student and client perceptions of telehealth, and the effectiveness oftreatment.
Brenda K. Lyman, OTD, OTR/L
Division of Allied Health, Division of Health Professions, School of Health Sciences, Salt Lake Community College
Robyn Thompson, PhD, OTR/L
Assistant Professor and Program Director
Salt Lake Community College
11. Speech Therapy Services made Possible in a Rural Community via Telehealth Supervision and Mentorship
Background: Many rural hospitals struggle to recruit speech-language pathologists due to limited access to mentorship opportunities for new clinicians. The University of Utah and Ashley Regional Medical Center (ARMC) in Vernal, Utah partnered in January 2017 to provide supervision and mentorship to ARMC’s newly-hired speech-language pathologist.
Method: The use of telehealth connections provided a nationally-approved (ASHA) means of direct supervision for a clinical fellow (Justin) to complete his clinical fellowship and receive full state and national accreditation. Additionally, ARMC saved on travel expenses as the University supervisor was able to observe one or two sessions at a time without the time commitments of traveling to Vernal.
Results: The direct supervision provided through telehealth gave ARMC an opportunity to recruit and hire a clinical fellow who developed a thriving speech therapy program. His presence and development of the speech program provided access to 542 pediatric and adult patients who would have otherwise had to travel to Provo or Salt Lake City, Utah for the nearest clinician.
Conclusion: Rural hospitals often struggle to recruit full-time therapists to their facilities. Hiring clinical fellows also proves difficult as fellows require a clinical supervisor to provide direct supervision. Offering a clinical fellowship through telehealth supervision provides rural hospitals with a wider field of applicants as well as provides more occupation opportunities in a hospital setting for clinical fellows. Access to direct supervision via telehealth services was a viable solution and provided Justin access to a supervisor without travel needs or expenses. The opportunity for a clinical fellow to begin a speech therapy program in a rural community was made possible by telehealth services and has resulted in a significant health benefit to the Vernal community.
Justin Benson, M.Ed.; CCC-SLP
Ashley Regional Medical Center
Sarah Gallant, MS, CCC-SLP
University of Utah
12. UW TASP: Implementing Antimicrobial Stewardship in Critical Access Hospitals in WA State
Background: In January 2017 The Joint Commission mandated antimicrobial stewardship (AS) for critical access hospitals (CAHs). In July 2017, Medicaid included AS in its quality incentive program. The Centers for Disease Control and Prevention (CDC) have outlined core elements of effective antimicrobial stewardship programs (ASPs). Many CAHs lack resources to fully implement ASPs. Tele-antimicrobial stewardship is highlighted in the Federal Register as a potential solution.
Methods: Launched in January 2017, UW TASP ECHO is tele-conference solution to the problem of limited resources for ASPs at CAHs. This interdisciplinary collaboration involves infectious diseases (ID) faculty and fellows, ID pharmacists, and microbiologists from UW Medicine; epidemiologists from Washington State Department of Health; program/technical support staff; and AS teams from participating institutions, forming one large ASP in Washington (WA) State. Using the ECHO model, interactive weekly meetings provide CME via didactics and facilitate peer-to-peer case reviews and sharing of policies, procedures, and protocols. Site visits to participating hospitals allow understanding of local workflow and customized interventions.
Results: 22 of 39 CAHs participate. Gap analysis for the CDC Core Elements reveals areas for improvement at many sites; specific remediation plans are being formulated. Clinical and programmatic toolkits have been developed and shared across the network. Participants share antibiotic formularies and antibiograms where available and discuss challenges unique to CAHs. Providers report a high degree of satisfaction with the program due to AS improvements, knowledge gained, and community enhanced interprofessional communication. Public health benefits include improved local data sharing. National data reporting to NHSN’s antibiotic use and resistance options is encouraged. Impact on antimicrobial use and resistance is being tracked, although it is too early to measure effects.
Conclusion: UW TASP has effectively facilitated inter-hospital engagement and collaboration among 56% of WA CAHs, effectively supporting AS programs in smaller hospitals across large geographic regions
Natalia Martinez-Paz, MPA, MA
University of Washington Tele-Antimicrobial Stewardship Program (UW TASP)