Rheum Service: Comprehensive Virtual Care During COVID-19

Background/Purpose: During COVID-19, patients require timely access to rheumatologists while adhering to physical distancing guidelines In this quality improvement project, we developed a comprehensive virtual pathway for rheumatology consults in a new community practice We aimed to deliver a virtual experience, called "Rheum Service", which rivaled or exceeded traditional in-person care Methods: We used quality improvement methods to implement a virtual process with three phases: pre-visit, visit, and post-visit In the pre-visit phase, we emailed appointment details and digital questionnaires to patients, and offered training for video-calls In the visit phase, we enlisted multiple secure video platforms in case of technical difficulties In the post-visit phase, we offered patients a digital consultation report and access to secure physician messaging Our outcome measures were the percentage of 1) consults using video-calling;2) patients interested in future video appointments;and 3) video-visit diagnoses that changed after in-person visits We collected data for all new consults between April 8 - June 11, 2020, and we emailed anonymized patient experience surveys one week after all video consults Results: Pre-visit, we scheduled 135 new patients in the 10 week study period;119 (88%) by video, 15 (11%) by phone, and 1 (1%) by office visit Twenty-one patients (16%) did not have a video-enabled device, 6 of whom borrowed a device Prior to their appointment dates, 88% (119/135) of all patients completed questionnaires, and 10% (12/119) of the video cohort participated in video training We completed 98% (116/119) of scheduled video consults During these visits, 6% (7/116) suffered technical difficulties, requiring a switch to phone or another video platform Post-visit, all patients with email (125/135, 93%) received a secure message containing a summary report Of these patients, 38% (48/125) sent their rheumatologist at least one question through the secure messaging system Our post-visit survey was completed by 38% (48/125) of patients, most of whom were satisfied with their virtual experience (Figure 1) When asked if they would like to have another appointment by video, 68% (32/48) said 'yes', 28% (13/48) were 'not sure', and 4% (2/48) declined Within the study period, 38 patients had an in-person follow-up visit;84% (32/38) maintained the same diagnosis from their video consult, while 16% (6/38) had a revised diagnosis Conclusion: We delivered high quality virtual care to new rheumatology patients during the COVID-19 pandemic Our interventions reduced barriers to video consults and increased communication through digital channels We believe that more patients could benefit from virtual care by improving access to video-enabled devices and providing pre-visit training