#YuanRule #CircHFJC

@MKIttlesonMD A tip fr tech/design: There’s no such thing as “User error”, only mismatches b/t the right technology for the right Pts/clinicians. Remote care might be convenient but requires thoughtful implementation and might not be for everyone. Know when your patient needs to come in.

😆 Nearly impossible to be as pithy/wise as @MKittlesonMD. But here's my best shot at a lesson from this study. #CircHFJC /1

A6: ❓Outcomes: Does use result in better process measures, long term outcomes? ❓Cost-effectiveness: Is the 🍋 worth the squeeze? Are the infrastructure/personnel costs worth the benefits gained? Are there other cheaper/easier ways of getting at the same information?#CircHFJC /3

A6: ❓Descriptive: Who uses it and who doesn’t/can’t? (Consider both patients and clinicians). Is the data reliable/actionable? What’s the monitored data show? ❓Qualitative: Why do/don’t they use it? How do they use it? #CircHFJC /2

A6: Every time you think about a remote care/monitoring intervention, consider these research ❓s. #CircHFJC /1

A5: Some ?s on my mind: Which HF patients may still do ok with remote visits? Can we compensate for remote visit shortcoming if we use video visits + the right remote monitoring devices Prospective trials. Always potential confounding by indication w/ retro study. #CircHFJC 1/1

A4: ⭐️Awareness of providing less care compared to in-person. Are you not ordering meds/tests b/c u can’t get clear a history/exam? ⭐️Recognize that remote visits (esp video) might not be for everyone. Some may need to come into the office for proper management. #CircHFJC 3/3

A4: ⭐️Have staff spend time before visits orient patients to hardware/software ⭐️Send patients or have them buy monitoring devices such as BP cuffs, HR monitors, scale (doesn't have to be fancy, just to get data you might need during your visit) #CircHFJC /2

A4: Clearly, remote care has tons to offer for improving accessibility, but like any new technology, there will be a learning curve. Here are some ⭐️ to think about for improving remote care: #CircHFJC /1

A3: Next step is definitely to consider other CV conditions. We might not see major differences in outcomes in conditions that are less exam intensive. E.g. CAD, a high risk condition, but might still be OK to monitor remotely if you can get a good history. #CircHFJC 2/2

A3: Patients with HF were our first grp of interest b/c they seemed to be highest risk. i.e. high rates of admissions, mortality and often require more physical exam monitoring that might be challenging over remote visits. #CircHFJC /1

A2: SES. Using insurance as an imperfect proxy for SES, Pts with private insurance were a bigger proportion of video visits compared to Pts with Medicaid/Medicare. #CircHFJC 5/5

A2: Age: Not surprisingly, video visits were accessed by younger Pts (mean age in-person 74, video: 64, tele: 73). Still, though, avg age for video visits was 64+/-14, so plenty of 🧓👴 completing video visits #CircHFJC /4

A2: ♀️♂️: Men made up a higher proportion of video visits. Women had a higher proportion of telephone visits. #CircHFJC /3

But interestingly, we found that non-white Pts made up similar if not higher proportion of video visits. Also true for telephone visits. /2

A2: Race/ethnicity. B/c of association b/t race and SES, had hypothesized that non-white Pts might have less access to internet, devices, and therefore video visits. /1

A1: Similarly, had several patients where doing remote visits, or at least video visits, was nearly impossible. No digital devices, internet, technical know-how. So another questions was whether we were simply leaving some patients behind. #CircHFJC 4/4

A1: I found that personally was more hesitant about Rx’ing certain meds E.g. ACE/ARBs, diuretics w/o exam, no way to monitor kidneys. I wanted to know if this was similar for other physicians and whether this was affecting care quality overall. #CircHFJC /3

A1: Even basic issues, like bad call quality, soft talking, hearing issues, had significant effects on visit quality. Caused me to wonder how this shift in care delivery was changing what we do #CircHFJC /2