![]() Patients were provided with instructions and assistance in installation of this application at the time of consent. Patient access to video visits was enabled through the health system's EHR patient portal application. Video visits were conducted from a dedicated clinic or conference room. Patients were consented for CardioClick during their first in-person visit or were virtually e-consented.Ĭlinicians were trained to use the video visit platform, which was integrated with the electronic health record (EHR). Those who did not meet age criteria or did not wish to enroll continued usual care in the traditional in-person prevention program. ![]() New patients were enrolled in CardioClick by default. Eligibility for CardioClick was limited to patients aged 18 to 63 to restrict the program to those with private insurance as Medicare did not reimburse for video visits at the time. Patients then receive personalized treatment focused on intensive risk reduction through lifestyle interventions and pharmacotherapy as indicated.ĬardioClick, a telemedicine program replacing in-person follow-up visits with video visits, was fully implemented in this prevention clinic in 2018. Patients undergo a comprehensive risk assessment, including an advanced cardiometabolic laboratory panel. Patients enrolled in the prevention clinic complete an initial visit and at least two follow-up visits with a physician and a registered dietician over a six-month period. The clinic care team includes cardiologists, registered dieticians, and an insulin resistance specialist. This study was conducted in a preventive cardiology clinic focused on primary cardiovascular disease prevention in high-risk South Asian adults. 19, 20 In this study, we use the Quadruple Aim as a standardized approach to evaluate the operational impact of CardioClick, a telemedicine program introduced in a preventive cardiology clinic at an academic medical center. ![]() 19 The Quadruple Aim builds on the Triple Aim by adding the goal of enhancing the clinician experience in order to address the challenge of clinician burnout and the central role of clinicians in the successful adoption of care delivery interventions. The Triple Aim is a widely accepted, standardized framework of three goals that clinical programs should strive to achieve: improving population health, reducing costs, and enhancing the patient experience. Most institutions lack a standardized approach to evaluate telemedicine programs. Institutions must systematically assess these operational impacts to fully evaluate telemedicine programs and guide future investments. 10, 15, 18 Replacing in-person visits with video visits may have significant effects on clinic efficiency, patient flow, and clinician workload. 5, 15, 16, 17 Importantly, there is limited evidence on the impact of video visits and other virtual encounters on clinic operations. 9, 10, 11, 12, 13, 14 Telemedicine implementation has also been associated with equal or higher patient and clinician satisfaction when compared to traditional in-person care in diverse practice settings. Previous studies have demonstrated that telemedicine can be used to effectively deliver preventive care and manage chronic diseases, such as diabetes and cardiovascular disease. 6, 7 As such, it is critical for institutions to assess the impact of telemedicine programs on care delivery to determine the optimal level of investment in these services. 2, 3, 4, 5 It is predicted that this shift to telemedicine during the COVID-19 pandemic will lead to the permanent inclusion of virtual care delivery models in health systems. 1, 2 Telemedicine has allowed primary care and specialty clinics to continue delivering services while minimizing risk to patients and clinicians. The COVID-19 pandemic has resulted in the rapid adoption of telemedicine services in outpatient clinics.
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