A Stepwise Transition to Telemedicine in Response to COVID-19

With the emergence of COVID-19, many primary care offices closed their physical space to limit exposure. Despite decades of telemedicine in clinical practice, it is rare to find it used in small-metro and academic settings. Following the decision to limit face-to-face care, we tracked our practice's transition to telemedicine.

This was a prospective quality improvement project following Plan-Do-Study-Act (PDSA) cycles to optimize the use of telemedicine (both telephone and video in this practice) encounters. Central to the PDSA cycles was the use of a post-encounter questionnaire to track patient, appointment, and physician factors. Throughout the cycles, inferential statistics were used to inform process improvement.

In Cycle 2, a logistic regression model showed length of encounter, need for physical examination, and physician satisfaction correctly predicted a physician's preferred medium (χ²(3) = 40.56, P < .001). In Cycle 3, a χ² test showed the reason for visit predicted the preferred medium (χ²(4) = 47.30, P < .001). In cycle 4, week of telemedicine, need for physical examination, length of encounter and physician satisfaction predicted the preferred medium (χ²(9) = 172.52, P < .001).

Using the variables that predicted preference for telemedicine, we were able to adjust our processes through PDSA cycles.

Early use of the PDSA cycle allows for informed quality improvement at the local level. Our findings highlight factors to consider when implementing telemedicine such as need for physical examination and type or length of encounter. In addition, physician satisfaction can encourage use of telemedicine, and tools for learning and practicing telemedicine should be available.