Application of the Quadruple Aim to evaluate the operational impact of a telemedicine program

Neil M Kalwani; Katherine M Wang; Austin N Johnson; Jahnavi D Deb; Thomas Gold; Akhil K Maddukuri; Emily G Savage; Vijaya Parameswaran; Rajesh Dash; David Scheinker; Fatima Rodriguez

doi:10.1016/j.hjdsi.2021.100593

Application of the Quadruple Aim to evaluate the operational impact of a telemedicine program

Healthc (Amst). 2021 Dec;9(4):100593. doi: 10.1016/j.hjdsi.2021.100593. Epub 2021 Nov 5.

Authors

Affiliations

¹ Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA.
² Division of Nephrology, Stanford University School of Medicine, Stanford, CA, USA.
³ Stanford University School of Medicine, Stanford, CA, USA.
⁴ Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
⁵ Stanford Graduate School of Business, Stanford, CA, USA.
⁶ Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
⁷ Department of Management Science and Engineering, Stanford University, Stanford, CA, USA; Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
⁸ Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: frodrigu@stanford.edu.

Abstract

Background: In response to the COVID-19 pandemic, telemedicine utilization has increased dramatically, yet most institutions lack a standardized approach to determine how much to invest in these programs.

Methods: We used the Quadruple Aim to evaluate the operational impact of CardioClick, a program replacing in-person follow-up visits with video visits in a preventive cardiology clinic. We examined data for 134 patients enrolled in CardioClick with 181 video follow-up visits and 276 patients enrolled in the clinic's traditional prevention program with 694 in-person follow-up visits.

Results: Patients in CardioClick and the cohort receiving in-person care were similar in terms of age (43 vs 45 years), gender balance (74% vs 79% male), and baseline clinical characteristics. Video follow-up visits were shorter than in-person visits in terms of clinician time (median 22 vs 30 min) and total clinic time (median 22 vs 68 min). Video visits were more likely to end on time than in-person visits (71 vs 11%, p < .001). Physicians more often completed video visit documentation on the day of the visit (56 vs 42%, p = .002).

Conclusions: Implementation of video follow-up visits in a preventive cardiology clinic was associated with operational improvements in the areas of efficiency, patient experience, and clinician experience. These benefits in three domains of the Quadruple Aim justify expanded use of telemedicine at our institution.

Implications: The Quadruple Aim provides a framework to evaluate telemedicine programs recently implemented in many health systems.

Level of evidence: Level III (retrospective comparative study).

Keywords: Cardiovascular disease; Efficiency; Preventive medicine; Telemedicine.

MeSH terms

COVID-19*
Female
Humans
Male
Middle Aged
Pandemics
Retrospective Studies
SARS-CoV-2
Telemedicine*

Abstract

MeSH terms

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