Increasing Healthcare Connectivity Among Home-Based Palliative Care Patients

From the 2022 HVPA National Conference

Donna Stevens (Lehigh Valley Health Network), Kathryn Zaffiri MPH, Donna Stevens MHA, Lisa Hageman MSW, Jennifer Allen MD, Jessica Fenton MSW, Patricia Poblete BSN

Objectives

– Decrease disparities in virtual healthcare access through the distribution of iPad devices
– Increase healthcare engagement among home-based palliative care patients

Background

Healthcare is shifting to include more virtual delivery platforms. Resourced patients have more options to engage with the healthcare systems via internet connected devices. Patients without this technology have fewer options to access medical care and communicate with providers, ultimately, intensifying already present disparities in healthcare. The first wave of the COVID pandemic, when patients were encouraged to remain at home and engage with their healthcare team virtually, exacerbated and highlighted this disparity and its potential impact on our most vulnerable populations.

Methods

A $25,000 grant was awarded, and 60 iPads and cases were purchased. Patients were screened to determine if they had access to Wi-Fi, no existing appropriate smart device, and patient and/or caregiver interest and ability to utilize the smart device. A home visit was completed by a palliative medicine social worker or nurse to assist with iPad and MyChart set up. Patients were directed to online tools and contact information to troubleshoot technology concerns. The patient’s care team was notified of the device availability and encouraged to consider video visits. Patients’ encounters, visits and MyChart interactions were tracked six months pre and six months post each iPad deployment via internal data sources.

Results

During phase one of this project, 24 iPads were successfully deployed. During the 6 months prior to each iPad being given out a cumulative total of only 13 virtual visits had been completed among those 24 patients. 6 months after iPad distribution, this number rose to 53, equating to a 307% increase. Additionally, there was a 103% increase in MyChart usage (N=10,350 vs N=21,023), and a 25% increase in visits and encounters (N=2,050 vs N=2,564).

Conclusions

This project has offered the opportunity to realize not only the potential benefits, but also the challenges of encouraging virtual healthcare engagement through the provision of iPad devices in patient homes. Higher than expected resource allocation to allow for setup and education on the use of the iPad and MyChart portal were required. Potential harm exists in creating frustration and/or high levels of anxiety for the patient if they struggle or are unable to master use of the device as instructed.

Clinical Implications

The patients who received an iPad have increased access and are more connected to their healthcare team due to the availability of virtual visits and enrollment in the MyChart patient portal. More studies need to be done to further clarify the impact of enhanced patient connection to their healthcare team.

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