Development of an Intentional Telehealth Viewing Guide for Home-Based Patient Assessment

The increased use of telehealth to visit patients in their home permits greater access to care, and also increases the opportunity for whole-person assessments that improve individualized care. The videoconferencing camera is a proxy for home visit provider's eyes. However, cameras limit views, thereby reducing environmental cues. The Novice to Expert Theory of skill acquisition supports the use of an intentional viewing guide to assure a comprehensive patient assessment using telehealth in the home (CPATH). This study advances the development of a CPATH framework to guide providers to be intentional when using televideo technology.

A quantitative content validity approach was used to determine the validity of a priori items within domains that were in the original protocol framework. A content validity determination requires 5-10 experts to rate agreement (range 1-5) on items within domains. Our sample was composed of seven expert home health providers. More than five experts had to agree to achieve statistical significance (p < 0.05) for validity.

Of the 15 items in the protocol, only 8 items had significant agreement for the sample size. These items were breathing, nonverbal gesturing, positioning, oxygen, safety, and types, dosages, and administration guidance of medication. Other items were added within the existing domains of Patient Characteristics, Treatment and Equipment Functioning, Medications and Environmental Quality, with the exception of Caregivers.

The domains triggered considerations for existing or additional items that require assessment, thereby developing the intentional guide framework that permits individualization of a telehealth home-based visit.