The Evolution of Telehealth From Pre-COVID-19 Pandemic Through A Hybrid Virtual Care Delivery Model: A Pediatric Hospital’s Journey

Authors

  • Evelyn Abrahante Terrell Nicklaus Children’s Pediatric Virtual Care, Telehealth Center, Nicklaus Children’s Hospital, Miami, Florida, USA
  • Saima Aftab Nicklaus Children’s Pediatric Virtual Care, Telehealth Center, Nicklaus Children’s Hospital, Miami, Florida, USA
  • Anne Babitz Department of Rehabilitation Services, Nicklaus Children’s Hospital, Miami, Florida, USA
  • Lauren Butler Department of Rehabilitation Services, Nicklaus Children’s Hospital, Miami, Florida, USA
  • Nicole Gondar Hernandez Department of Rehabilitation Services, Nicklaus Children’s Hospital, Miami, Florida, USA
  • Bianca Hornik Department of Rehabilitation Services, Nicklaus Children’s Hospital, Miami, Florida, USA
  • Keysla Lee Department of Rehabilitation Services, Nicklaus Children’s Hospital, Miami, Florida, USA
  • Jennifer Perez Department of Rehabilitation Services, Nicklaus Children’s Hospital, Miami, Florida, USA
  • Elizabeth Sotolongo Nicklaus Children’s Pediatric Virtual Care, Telehealth Center, Nicklaus Children’s Hospital, Miami, Florida, USA
  • Jessica Thomas Department of Rehabilitation Services, Nicklaus Children’s Hospital, Miami, Florida, USA

DOI:

https://doi.org/10.5195/ijt.2021.6432

Keywords:

COVID-19, Early intervention, Pediatrics, Rehabilitation services, Telehealth

Abstract

The COVID-19 pandemic transformed care delivery and influenced telehealth adoption by rehabilitation professionals and their patients. The purpose of this paper is to describe a pediatric health system’s telehealth services pre-pandemic and how those services were scaled during the pandemic. A secondary aim is to provide a roadmap for the operational delivery of telehealth and rehabilitation services, including transition to a hybrid care delivery model. Findings suggested that telehealth can be rapidly scaled to address patient healthcare needs for an early intervention population during a pandemic. Telehealth use during the pandemic helped ensure continuity of care and likely reduced the risk of exposure to patients and staff to the virus. Benefits included enhanced access to care, and savings in time and money for families. Interestingly, as the pandemic declined, the use of telehealth services declined due to patient preference, with many families opting to request a return to in-person care.

 

  

Author Biographies

Evelyn Abrahante Terrell, Nicklaus Children’s Pediatric Virtual Care, Telehealth Center, Nicklaus Children’s Hospital, Miami, Florida, USA

NICKLAUS CHILDREN’S PEDIATRIC VIRTUAL CARE, TELEHEALTH CENTER, NICKLAUS CHILDREN’S HOSPITAL, MIAMI, FL, USA

Saima Aftab , Nicklaus Children’s Pediatric Virtual Care, Telehealth Center, Nicklaus Children’s Hospital, Miami, Florida, USA

NICKLAUS CHILDREN’S PEDIATRIC VIRTUAL CARE, TELEHEALTH CENTER, NICKLAUS CHILDREN’S HOSPITAL, MIAMI, FL, USA

Anne Babitz , Department of Rehabilitation Services, Nicklaus Children’s Hospital, Miami, Florida, USA

DEPARTMENT OF REHABILITATION SERVICES, NICKLAUS CHILDREN’S HOSPITAL, MIAMI, FL, USA

Lauren Butler, Department of Rehabilitation Services, Nicklaus Children’s Hospital, Miami, Florida, USA

DEPARTMENT OF REHABILITATION SERVICES, NICKLAUS CHILDREN’S HOSPITAL, MIAMI, FL, USA

Nicole Gondar Hernandez, Department of Rehabilitation Services, Nicklaus Children’s Hospital, Miami, Florida, USA

DEPARTMENT OF REHABILITATION SERVICES, NICKLAUS CHILDREN’S HOSPITAL, MIAMI, FL, USA

Bianca Hornik, Department of Rehabilitation Services, Nicklaus Children’s Hospital, Miami, Florida, USA

DEPARTMENT OF REHABILITATION SERVICES, NICKLAUS CHILDREN’S HOSPITAL, MIAMI, FL, USA

Keysla Lee, Department of Rehabilitation Services, Nicklaus Children’s Hospital, Miami, Florida, USA

DEPARTMENT OF REHABILITATION SERVICES, NICKLAUS CHILDREN’S HOSPITAL, MIAMI, FL, USA

Jennifer Perez, Department of Rehabilitation Services, Nicklaus Children’s Hospital, Miami, Florida, USA

JENNIFER PEREZ, MS, CCC-SLP

Elizabeth Sotolongo , Nicklaus Children’s Pediatric Virtual Care, Telehealth Center, Nicklaus Children’s Hospital, Miami, Florida, USA

NICKLAUS CHILDREN’S PEDIATRIC VIRTUAL CARE, TELEHEALTH CENTER, NICKLAUS CHILDREN’S HOSPITAL, MIAMI, FL, USA

Jessica Thomas, Department of Rehabilitation Services, Nicklaus Children’s Hospital, Miami, Florida, USA

DEPARTMENT OF REHABILITATION SERVICES, NICKLAUS CHILDREN’S HOSPITAL, MIAMI, FL, USA

 

References

Agency for Healthcare Administration [AHA]. (2020). Telemedicine guidance for therapy services and early intervention services. Agency for Health Care Administration. https://ahca.myflorida.com/Medicaid/pdffiles/provider_alerts/2020_03/Telemedicine_Guidance_Therapy_Services-EIS_20200320.pdf

Agency for Healthcare Research and Quality. [AHRQ]. (2017). The CAHPS ambulatory care improvement guide: Practical strategies for improving patient experience. Agency for Healthcare Research and Quality. https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/improvement-guide.html

Akhbari Ziegler, S. & Hadders‐Algra, M. (2020). Coaching approaches in early intervention and paediatric rehabilitation. Developmental Medicine & Child Neurology, 62(5), 569-574. https://doi.org/10.1111/dmcn.14493

American Occupational Therapy Association. [AOTA]. (2018). Telehealth in occupational therapy. American Journal of Occupational Therapy, 72(Supp 2), 1-18. https://doi.org/10.5014/ajot.2018.72S219

American Occupational Therapy Association. [AOTA]. (2021). Occupational therapy via telehealth for Medicare beneficiaries support the Expanded Telehealth Access Act (H.R.2168/S.TBD). CQ Engage. https://cqrcengage.com/aota/file/Z6wpbsnLGaG/Expanded-Telehealth-Access-Act-One-Pager.pdf

American Physical Therapy Association. [APTA]. (2021). Expanded Telehealth Access Act of 2021 (H.R. 2168). https://www.apta.org/contentassets/dfc514093b974104aea02e0cf0016562/position-paper-telehealth.pdf

American Speech-Language Hearing Association. [ASHA]. (2021). Early intervention. ASHA. https://www.asha.org/Practice-Portal/Professional-Issues/Early-Intervention/

American Telemedicine Association. [ATA]. (2021). ATA's Federal telehealth legislative tracker. https://www.americantelemed.org/policies/atas-federal-telehealth-legislative-tracker/

Baharav, E., & Reiser, C. (2010). Using telepractice in parent training in early autism. Telemedicine and E-Health, 16(6), 727-731. https://doi.org/10.1089/tmj.2010.0029

Bican, R., Christensen, C., Fallieras, K., Sagester, G., O'Rourke, S., Byars, M., & Tanner, K. (2021). Rapid implementation of telerehabilitation for pediatric patients during COVID-19. International Journal of Telerehabilitation, 13(1), e6371. https://doi.org/10.5195/ijt.2021.6371

Boisvert, M., Lang, R., Andrianopoulos, M., & Boscardin, M. L. (2010). Telepractice in the assessment and treatment of individuals with autism spectrum disorders: A systematic review. Developmental Neurorehabilitation, 13(6), 423-432. https://doi.org/10.3109/17518423.2010.499889

Boisvert, M., Hall, N., Andrianopoulos, M., & Chaclas, J. (2012). The multi-faceted implementation of telepractice to service individuals with autism. International Journal of Telerehabilitation, 4(2), 11-24. https://doi.org/10.5195/ijt.2012.6104

Cason, J. (2014). Telehealth: A rapidly developing service delivery model for occupational therapy. International Journal of Telerehabilitation, 6(1), 29-35. https://doi.org/10.5195/ijt.2014.6148

Cason, J. (2015). Telehealth and occupational therapy: Integral to the triple aim of health care reform. American Journal of Occupational Therapy, 69(2), 6902090010. https://doi.org/10.5014/ajot.2015.692003

Cason, J., Behl, D., & Ringwalt, S. (2012). Overview of states’ use of telehealth for the delivery of early intervention (IDEA Part C) services. International Journal of Telerehabilitation, 4(2), 39-46. https://doi.org/10.5195/IJT.2012.6105

Chuo, J., Macy, M. L., & Lorch, S. A. (2020). Strategies for evaluating telehealth. Pediatrics, 146(5), e20201781. https://doi.org/10.1542/peds.2020-1781

Comeau, R. (2020). Switching to telepractice: How to ensure a smooth transition. The Hanen Centre. https://www.hanen.org/MyHanen/Resource-Centre/Articles/Program-Updates/Switching-to-Telepractice--How-to-Ensure-a-Smooth-.aspx

Crow, S. J., Mitchell, J. E., Crosby, R. D., Swanson, S. A., Wonderlich, S., & Lancanster, K. (2009). The cost effectiveness of cognitive behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face. Behaviour Research and Therapy, 47(6), 451-453. https://doi.org/10.1016/j.brat.2009.02.006

Early Steps. (2021). Florida Health. http://www.floridahealth.gov/programs-and-services/childrens-health/early-steps/index.html

Florida's Early Steps System. (2020). Children's medical services. http://www.cms-kids.com/families/early_steps/early_steps.html

Hailey, D., Roine, R., Ohinmaa, A., & Dennett, L. (2011). Evidence of benefit from telerehabilitation in routine care: A systematic review. Journal of Telemedicine and Telecare, 17(6), 281-287. https://doi.org/10.1258/jtt.2011.101208

Harper, D. C. (2006). Telemedicine for children with disabilities. Children's Health Care, 35(1), 11-27. https://10.1207/s15326888chc3501_3

Hsu, N., Monasterio, E., & Rolin, O. (2021). Telehealth in pediatric rehabilitation. Physical Medicine and Rehabilitation Clinics of North America, 32(2), 307-317. https://doi.org/S1047-9651(20)30114-5

Individual with Disabilities Education Act [IDEA]. (2017). Sec. 303.344 Content of an IFSP. Individuals with Disabilities Education Act. https://sites.ed.gov/idea/regs/c/d/303.344

Ignatowicz, A., Atherton, H., Bernstein, C. J., Bryce, C., Court, R., Sturt, J., & Griffiths, F. (2019). Internet videoconferencing for patient–clinician consultations in long-term conditions: A review of reviews and applications in line with guidelines and recommendations. Digital Health, 5, 2055207619845831. https://doi.org/10.1177/2055207619845831

Jehle, D., Leggett, J., Short, R., Pangia, J., Wilson, C., & Gutovitz, S. (2020). Influence of COVID‐19 outbreak on emergency department Press Ganey scores of emergency physicians. Journal of the American College of Emergency Physicians Open, 1(6), 1413-1417. https://doi.org/10.1002/emp2.12287

Kairy, D., Lehoux, P., Vincent, C., & Visintin, M. (2009). A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disability and Rehabilitation, 31(6), 427-447. https://doi.org/10.1080/09638280802062553

Kemp, P., & Turnbull, A. P. (2014). Coaching with parents in early intervention: An interdisciplinary research synthesis. Infants & Young Children, 27(4), 305-324. https://doi.org/10.1097/IYC.0000000000000018

Krasovsky, T., Silberg, T., Barak, S., Eisenstein, E., Erez, N., Feldman, I., Guttman, D., Liber, P., Patael, S. Z., & Sarna, H. (2021). Transition to multidisciplinary pediatric telerehabilitation during the COVID-19 pandemic: Strategy development and implementation. International Journal of Environmental Research and Public Health, 18(4), 1484. https://doi.org/10.3390/ijerph18041484

Kronberg, J., Tierney, E., Wallisch, A., & Little, L. M. (2021). Early intervention service delivery via telehealth during COVID-19: A research-practice partnership. International Journal of Telerehabilitation, 13(1), e6363. https://doi.org/10.5195/ijt.2021.6363

Landinguin, R. (2020). Using telepractice to provide early intervention services to families. ASHAWire. https://leader.pubs.asha.org/do/10.1044/how-our-early-intervention-practice-serves-families-through-telepractice/full/

Lipkin, P. H., & Macias, M. M. (2020). Promoting optimal development: identifying infants and young children with developmental disorders through developmental surveillance and screening. Pediatrics, 145(1), e20193449. https://doi.org/10.1542/peds.2019-3449

Little, L. M., Pickett, K. A., Proffitt, R., & Cason, J. (2021). Keeping PACE with 21st Century healthcare: A framework for telehealth research, practice, and program evaluation in occupational therapy. International Journal of Telerehabilitation, 13(1), e6379. https://doi.org/10.5195/ijt.2021.6379

Longacre, C. F., Nyman, J. A., Visscher, S. L., Borah, B. J., & Cheville, A. L. (2020). Cost‐effectiveness of the Collaborative Care to Preserve Performance in Cancer (COPE) trial tele‐rehabilitation interventions for patients with advanced cancers. Cancer Medicine, 9(8), 2723-2731. https://doi.org/10.1002/cam4.2837

Nissen, R. M., Hersch, G., Tietze, M., & Chang, P. J. (2018). Persons with dementia and their caregivers' perceptions about occupational therapy and telehealth: A qualitative descriptive study. Home Healthcare Now, 36(6), 369-378. https://doi.org/10.1097/NHH.0000000000000697

Notario, P. M., Gentile, E., Amidon, M., Angst, D., Lefaiver, C., & Webster, K. (2019). Home-based telemedicine for children with medical complexity. Telemedicine and E-Health, 25(11), 1123-1132. https://doi.org/10.1089/tmj.2018.0186

Olson, C. A., McSwain, S. D., Curfman, A. L., & Chuo, J. (2018). The current pediatric telehealth landscape. Pediatrics, 141(3), e20172334. https://doi.org/10.1542/peds.2017-2334

Onofri, A., Pavone, M., De Santis, S., Verrillo, E., Caggiano, S., Ullmann, N., & Cutrera, R. (2021). Telemedicine in children with medical complexity on home ventilation during the COVID‐19 pandemic. Pediatric Pulmonology, 56(6), 1395-1400. https://doi.org/10.1002/ppul.25289

Peretti, A., Amenta, F., Tayebati, S. K., Nittari, G., & Mahdi, S. S. (2017). Telerehabilitation: Review of the state-of-the-art and areas of application. JMIR Rehabilitation and Assistive Technologies, 4(2), e7. https://doi.org/10.2196/rehab.7511

Rakap, S., & Rakap, S. (2014). Parent-implemented naturalistic language interventions for young children with disabilities: A systematic review of single-subject experimental research studies. Educational Research Review, 13, 35-51. https://doi.org/10.1016/j.edurev.2014.09.001

Richmond, T., Peterson, C., Cason, J., Billings, M., Terrell, E. A., Lee, A. C. W., Towey, M., Parmanto, B., Saptono, A., Cohn, E. R., & Brennan, D. (2017). American Telemedicine Association's principles for delivering telerehabilitation services. International Journal of Telerehabilitation, 9(2), 63-68. https://doi.org/10.5195/ijt.2017.6232

Ross, M. H., Parnell, L. S., Spears, T. G., & Ming, D. Y. (2020). Telemedicine video visits for children with medical complexity in a structured clinical complex care program. Global Pediatric Health, 7, 2333794X20952196. https://doi.org/10.1177/2333794X20952196

Shortell, S. M., Blodgett, J. C., Rundall, T. G., Henke, R. M., & Reponen, E. (2021). Lean management and hospital performance: Adoption vs. implementation. The Joint Commission Journal on Quality and Patient Safety, 47(5), 296-305. https://doi.org/10.1016/j.jcjq.2021.01.010

Snodgrass, M. R., Chung, M. Y., Biller, M. F., Appel, K. E., Meadan, H., & Halle, J. W. (2017). Telepractice in speech–language therapy: The use of online technologies for parent training and coaching. Communication Disorders Quarterly, 38(4), 242-254. https://doi.org/10.1177/1525740116680424

Suso-Martí, L., La Touche, R., Herranz-Gómez, A., Angulo-Díaz-Parreño, S., Paris-Alemany, A., & Cuenca-Martínez, F. (2021). Effectiveness of telerehabilitation in physical therapist practice: An umbrella and mapping review with meta–meta-analysis. Physical Therapy, 101(5), pzab075. https://doi.org/10.1093/ptj/pzab075

Theodoros, D., Russell, T., & Latifi, R. (2008). Telerehabilitation: Current perspectives. Studies in Health Technology and Informatics, 131(1), 191-210.

Tohidast, S. A., Mansuri, B., Bagheri, R., & Azimi, H. (2020). Provision of speech-language pathology services for the treatment of speech and language disorders in children during the COVID-19 pandemic: Problems, concerns, and solutions. International Journal of Pediatric Otorhinolaryngology, 138, 110262. https://doi.org/10.1016/j.ijporl.2020.110262

Tomines, A. (2019). Pediatric telehealth: Approaches by specialty and implications for general pediatric care. Advances in Pediatrics, 66, 55-85. https://doi.org/10.1016/j.yapd.2019.04.005

Utidjian, L., & Abramson, E. (2016). Pediatric telehealth: Opportunities and challenges. Pediatric Clinics of North America, 63(2), 367-378. https://doi.org/10.1016/j.pcl.2015.11.006

Vismara, L. A., Young, G. S., & Rogers, S. J. (2012). Telehealth for expanding the reach of early autism training to parents. Autism Research and Treatment, 2012https://doi.org/10.1155/2012/121878

Wallisch, A., Little, L., Pope, E., & Dunn, W. (2019). Parent Perspectives of an occupational therapy telehealth intervention. International Journal of Telerehabilitation, 11(1), 15-22. https://doi.org/10.5195/ijt.2019.6274

Wood, E., Bhalloo, I., McCaig, B., Feraru, C., & Molnar, M. (2021). Towards development of guidelines for virtual administration of paediatric standardized language and literacy assessments: Considerations for clinicians and researchers. SAGE Open Medicine, 9, 20503121211050510. https://doi.org/10.1177/20503121211050510

Downloads

Published

2021-12-01

How to Cite

Terrell, E. A., Aftab, S., Babitz, A., Butler, L., Hernandez, N. G., Hornik, B., … Thomas, J. (2021). The Evolution of Telehealth From Pre-COVID-19 Pandemic Through A Hybrid Virtual Care Delivery Model: A Pediatric Hospital’s Journey. International Journal of Telerehabilitation, 13(2). https://doi.org/10.5195/ijt.2021.6432

Issue

Vol. 13 No. 2 (2021)

Section

Clinical Practice - COVID 19

Most read articles by the same author(s)