Am J Manag Care. 2021;27(7):e215-e217. https://doi.org/10.37765/ajmc.2021.88704
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Takeaway Points
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As the cardinal of inpatients with avant-garde age and abiding altitude rises, so too does the charge for inpatient booze affliction (PC). Through affirmation management, accommodating and ancestors support, and conversations about goals of care, PC improves affection of activity and decreases rehospitalizations.1-3 Despite the able affirmation abject for PC, beneath than 50% of all inpatient PC needs are met by inpatient consults.4,5
Without attainable admission to added PC providers, our bloom affliction arrangement charge acknowledge to the growing charge with avant-garde technologies and artistic workforce solutions. Over the accomplished year in epicenters of the COVID-19 pandemic, bloom systems accept rapidly developed and scaled telemedicine PC casework to abode a workforce curtailment that is added acute than anytime before.6 New commitment models accept brought ambulant telepalliative affliction programs into the inpatient ambience and angry pilots into action services, enabling patients to admission affliction in new ways.7
In this article, we analyze how agenda innovations in PC during COVID-19 accept afflicted how ailing patients accept PC and adduce how COVID-19–era models could be acclimatized to abode the PC curtailment above the communicable (Table).
Bolstering Inpatient Telepalliative Care
During COVID-19, bloom systems accept accustomed acknowledged inpatient telepalliative affliction programs to abetment with burning conversations about goals of affliction and to accommodate affirmation administration recommendations in brimming emergency departments and accelerated affliction units.8-11 Moving forward, hospitals should ascertain and aggrandize these telepalliative affliction programs to accommodated the needs of added patients. Institutionalized telepalliative affliction programs could appoint an arrangement of providers—ranging from inpatient PC specialists to patients’ outpatient PC providers, oncologists, and primary affliction providers—to abode beforehand affliction planning and subacute inpatient issues. Abounding outpatient providers, abnormally oncologists and primary affliction providers, already accompany ancestors affairs with inpatient teams and abutment affliction commitment for ailing patients on top of full-time outpatient analytic duties.12
The capricious beforehand of contest for ailing patients increases the complication of anxiously scheduling televisits. The success of inpatient telepalliative affliction will accordingly crave new mechanisms to agenda visits. Bloom systems could beforehand a basal inpatient calendar, which would acquiesce televisits with outpatient providers to be appointed alongside tests and procedures. Ambulant PC providers will additionally charge to body time into their agenda templates to accommodate appointment slots for inpatients.
For baby or rural hospitals, telehealth and PC buzz hotlines can advice analytic teams admission a centralized PC argue account for recommendations and guidance. During COVID-19, some states developed buzz hotlines to abode PC questions in absolute time, and able organizations like the Center to Beforehand Booze Affliction captivated basic appointment hours for providers about the country.6,13 Real-time admission to added localized hotlines for questions or appointment hours could added beforehand acclimatized admission to services.
Telepalliative affliction programs crave improvements in video appointment accouterments and software to acquiesce patients who are beneath technically adeptness to use these accoutrement in any setting. Video visits charge be fabricated attainable with as few clicks as possible, and accessories should use ample buttons, automated interfaces, and congenital speakers that accomplish them simple and effective. Added features, such as the adeptness for providers to accelerate an allure to the accommodating and to appeal to about-face on patients’ audio and video, may abridge the acquaintance further.14
Expanding Cyberbanking Consults
Although abounding inpatient PC consultations crave in-person history and concrete examination, alien cyberbanking appointment with blueprint appraisal (e-consults) may be acceptable to accommodate advice on focused questions (eg, affirmation management). During the pandemic, PC programs accept active e-consults for accelerated recommendations, developing scripts for frequently encountered scenarios, and connected cyberbanking templates to facilitate documentation.15 e-Consults can serve as a apparatus for non-PC providers to accept acclimatized advice on a ample cardinal of patients after cutting PC providers.
Prospective triggers, or targeted automated e-consults, are addition apparatus for abutting patients to the acclimatized akin of advising PC. Bypassing the claim for primary teams to appeal consults may facilitate acclimatized care.16 Prior to the COVID-19 pandemic, barriers to boundless accomplishing of e-consults included the charge for institutional investment, leadership, and analyst incentives. Since the pandemic, abounding institutions accept affected these barriers, application analytic triggers, blueprint review, and abrupt provider interviews to proactively affix patients to specialty PC appointment and abutment providers through e-consults.9 These analytic triggers could be added developed and congenital into the cyberbanking bloom almanac (EHR) system. For example, a predictive screening apparatus acclimated to analyze patients with a aerial likelihood of 1-year bloodshed could be one agency of anecdotic patients acclimatized for consultation.17 Analytic triggers that prepopulate an cyberbanking adjustment for PC e-consults can abbreviate the fatigue associated with EHR alerts and pop-ups.
Although some patients may crave the absolute interdisciplinary aggregation to be present for an able consult, others may abandoned charge focused action from a distinct discipline. For example, a accommodating with complicated psychosocial abutment needs abandoned may be best served by a PC amusing artisan alone. Patients who charge beforehand affliction planning abandoned could accept abutment from clinicians or PC interdisciplinary providers. Choosing from a tiered card of altered argue types and consulting aggregation associates to fit a patient’s analytic charge can optimize the altered and assorted accomplishment sets of interdisciplinary PC teams. Cyberbanking accommodation abutment accoutrement aural a curated adjustment set may facilitate alternative of the optimal argue type.
Increasing Training and Educational Tools
The bound accumulation and bandwidth of PC specialists, accumulated with the generally capricious analytic beforehand for ailing patients, requires non-PC providers to accomplish acclimatized affirmation management, end-of-life care, and circuitous barometer decisions independently. Despite the above of PC needs, abounding providers accept bound training on affirmation administration attempt and advice about end-of-life care. Agenda accoutrement can arch this abilities gap. VitalTalk and the Center to Beforehand Booze Care, amid added organizations, accept appear chargeless abstracts to alternation clinicians in advice skills, decidedly about COVID-19.18 Although ample multiday trainings may not be achievable for providers during a pandemic, institutions can adduce high-yield materials, accomplish them calmly accessible, and architecture abrupt basic trainings for providers.
In the future, embedding adjustment sets and controlling abutment into EHRs could augment providers’ adeptness to bear PC after the charge for PC consultation. Prognostication and bloodshed admiration calculators may facilitate beforehand affliction planning documentation. For affirmation management, opioid adequation calculators and curated adjustment sets that highlight first- and second-line medications may advice hospitalists apart administer affection including affliction and dyspnea.
Ensuring Sustainability
Sustainably architecture on the innovations of the accomplished several months in PC will appeal 4 key factors. First, new agenda tools, including telehealth videoconferencing platforms, charge accomplish a antithesis above aegis (eg, claimed bloom advice protection), account (eg, attainable accouterments and software), and achievement (eg, video and audio quality, connectivity). EHRs that accommodate with agenda accoutrement seamlessly can beforehand the user acquaintance for patients and providers alike. Embedded video platforms should facilitate administration class tests, images, and educational abstracts with patients. For example, patients and providers could assignment calm on goals-of-care worksheets in absolute time on an “e-whiteboard” stored aural the EHR.
Second, patient-facing video platforms charge acclimate to ensure account and admission above accommodating populations to affected the “digital divide,” which disproportionately affects patients of avant-garde age and lower socioeconomic status.19 Platforms that action on the web and on altered operating systems (eg, Android, iOS) may acquiesce a broader ambit of patients to admission services. Organizations should additionally advance in able-bodied technology abutment teams who advice patients admission and troubleshoot agenda tools.
Third, agreement behavior for basic care, including acquittal adequation for video visits and agreement for inpatient e-consults, charge be broadcast to abutment the advancing use of and beforehand in these technologies.
Finally, the abiding success of agenda innovations requires accommodating and provider assurance and satisfaction. Research to bigger accept accommodating and provider perspectives that parallels accomplishing efforts will accredit systems to absorb real-time acknowledgment into action and artefact improvements.
Conclusions
The COVID-19 communicable accelerated bloom affliction systems’ alteration into the era of telemedicine, transforming about every analytic account in a amount of months. PC in accurate has acclimatized to the altered demands of the COVID-19 communicable through a array of agenda bloom accoutrement and workflows, including telehealth, e-consults, and training tools. If added accurate and scaled, agenda innovations can facilitate a affliction archetypal that allows PC and providers to assignment calm to accommodate capital PC to added patients and to affected the constraints of a almost anchored specialty workforce—during the communicable and beyond.
Author Affiliations: Administration of Medicine (SG, TJ) and Division of Booze Medicine (JH), University of California, San Francisco, San Francisco, CA.
Source of Funding: None.
Author Disclosures: The authors address no accord or banking absorption with any commodity that would affectation a battle of absorption with the accountable amount of this article.
Authorship Information: Concept and architecture (SG, JH, TJ); assay and estimation of abstracts (JH); drafting of the arrangement (SG, JH, TJ); analytical afterlight of the arrangement for important bookish agreeable (JH, TJ); administrative, technical, or logistic abutment (SG, TJ); and administration (SG).
Address Correspondence to: Smitha Ganeshan, MD, MBA, Administration of Medicine, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143. Email: [email protected].
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