The Board of Regents of the University of Oklahoma Health Sciences Center

PROJECT PURPOSE

This project aims to advance the telehealth and virtual training capacity of Oklahoma nursing homes (NH) by 1) investing in digital infrastructure needed to expand telehealth; 2) providing telehealth implementation and technology support to maximize this investment; and 3) providing direct care staff training in best practices and quality improvement using video-conferencing (Project ECHO). This project will support the distribution of 2 smart tablets to all Oklahoma NHs to conduct telehealth visits, virtual family visits, and staff education. NHs will also receive support in developing workflows and electronic health record templates for telehealth visits using HIPAA-compliant platforms, clinical training in telehealth best practices, and billing support. We will supply hand-held amplifiers for use with hearing-impaired residents and additional equipment as needed to support internet connectivity and use of virtual platforms (WiFi boosters, webcams). This statewide strategic investment in long-term care health technology infrastructure provides the necessary implementation support to make telehealth sustainable in long-term care. This work is critical to the creation of a statewide sustainable disaster recovery plan for long-term care, including possible re-emergence of COVID-19 or other unforeseen events that may require NHs to have virtual access to physicians, specialty care, staff training, and/or resident family members.

EVIDENCE

Telehealth in NHs has successfully increased real-time physician visits, saved organizational resources, and reduced hospitalizations. (https://pubmed.ncbi.nlm.nih.gov/34614517/) However, telehealth uptake has been more limited in NHs than other settings. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883984/) Barriers include workflow and tech-usability challenges and inadequate infrastructure. This project directly addresses these barriers by providing needed equipment and training in telehealth implementation using highly-trained QI and health IT experts. Trained facilitators have improved quality of care outcomes in NHs. (https://doi.org/10.1186/s12913-021-06803-8) Our group has also successfully used Project ECHO (case-based tele-mentoring using Zoom) to train 265 NHs, including over 170 in Oklahoma (https://www.ahrq.gov/nursing-home/nursing-home-network.html).

POPULATION DESCRIPTION

Oklahoma?s nursing home community has been hard hit by the COVID-19 pandemic with high rates of resident mortality, decline in long-term care quality metrics, significant staff losses, recurrent outbreaks, and resultant industry financial losses. Developing a more sustainable healthcare technology infrastructure and staff well-equipped to use telehealth is a key strategy in the preparedness, response, and recovery from COVID-19 as well as any future disaster. Telehealth is also a key strategy to improve access to specialty care for nursing home residents, including wound care, mental health, case management, physician visits, particularly in rural areas and areas with provider shortages. In our prior pilot with 30 nursing homes, providing smart tablets and staff training also improved work satisfaction, which is an important component of improving staff retention. OUHSC and OFMQ have previously worked together in this area, and have a strong track record of collaboration and project execution with high quality, sustainable deliverables. This project will increase the uptake and sustainability of telehealth for all 298 Oklahoma nursing homes by providing telehealth equipment and 6-months of implementation support with the goal of improving access and care quality for the vulnerable Oklahomans who need nursing home care.

PERFORMANCE MEASURING

We will measure project performance by tracking: 1) Project reach (number and location of NHs that receive telehealth equipment and complete 6-month implementation support) 2) Reach of training activities (# staff trained, session attendance, counties reached) 3) Knowledge gained and training relevance using Medical Director, Nurse and Administrator staff surveys 4) Telehealth uptake using Medicare telemedicine visit billing codes and telehealth place of service codes at participating NH sites from electronic health records 5) Family and resident surveys to assess satisfaction with virtual physician and family visits 6) Facility staff retention rates and long-term care quality metrics

ONGOING INVESTMENT AMOUNT

$

ONGOING INVESTMENT DESCRIPTION

None

ONGOING INVESTMENT REQUIRED

One-time project will not need continued funding