Qualitative Evaluation of Quality Measurement Within Emergency Clinician-Staffed Telehealth Programs

Emergency clinician-staffed telehealth programs seek to provide equitable, safe, efficient, effective, and patient-centered care. However, early studies show conflicting evidence on whether this aim is accomplished. Furthermore, how programs track the efficacy and safety of their programs remains largely unexplored. We sought to characterize ongoing quality monitoring among emergency clinician-staffed telehealth programs.

We identified representatives at emergency clinician-staffed telehealth programs through professional networks and published literature. Qualitative interviews were conducted, assessing quality metrics captured as well as motivations for and barriers to quality measurement. We classified quality metric measurement using the National Quality Forum Telehealth Measurement Framework Domains and Subdomains. We developed a codebook from interview transcripts for qualitative analysis to classify motivations for and barriers to quality measurement.

We held 8 qualitative interviews with physician representatives at primarily academic (7/8) and urban institutions (5/8). Most widely used quality metrics were related to patient and care team experience (7/8) as well as to access to care (6/8) and effectiveness (6/8). Few programs (2/8) measured finance-related quality metrics. Motivations for quality measurement varied considerably. Common barriers to implementation included technology challenges, data availability, and the lack of quality metric standardization.

We identified variation in the use and content of quality metrics across emergency clinician-staffed telehealth programs. Most commonly, programs used metrics related to clinical experience; financial metrics were rarely captured. Technology barriers to quality measurement were often cited across programs. Further work is needed to support the standardization and implementation of future quality measurement initiatives.