Virtual Visits at Brigham and Women's Hospital

Study Overview
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Brief Summary
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Clinicians slated for virtual visit rollout will be randomized (stratified by department) to either receive immediate virtual visit on-boarding (intervention arm) or delayed (3-months later) virtual visit on-boarding (control arm). The investigators plan to enroll no more than 200 clinicians. Any clinician in a department selected by the Brigham Health Virtual Care team for access to virtual visits is eligible, unless s/he saw less than 20 patients monthly over the last 6 months. The Brigham Health Virtual Care team will onboard all clinicians and provide virtual visit support as per their usual protocol. The primary study endpoint is third-available appointment, a well-adopted measure of access. Other secondary endpoints revolve around continuity, efficiency, utilization, safety, cost, and patient experience.

Detailed Description
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If enrolled in the intervention arm, the following steps will occur: The clinician will receive the intervention arm follow-up email (Follow-up Email - Intervention in the Appendix). The Brigham Health Virtual Care team will work with the clinician toward immediate on-boarding (software training, hardware setup, technical support) as per their usual process. The clinician will schedule virtual visits as s/he and/or her/his department see fit. Virtual visits occur on an already-in-use Partners- and Brigham-approved video platform (attached). If enrolled in the control arm, the following steps will occur: The clinician will receive the control arm follow-up email (Follow-up Email - Control in the Appendix). Three months from the time of the follow-up email, the Brigham Health Virtual Care team will work with the clinician toward immediate on-boarding (software training, hardware setup, technical support) as per their usual process. The clinician will schedule virtual visits as s/he and/or her/his department see fit. Virtual visits occur on an already-in-use Partners- and Brigham-approved video platform (attached). The investigators plan to follow patients of both clinician cohorts for a total of 6-months. The investigators will perform retrospective review of patient electronic health records and patients will receive a redcap survey (attached), an evaluation mechanism already employed by the Virtual Care team. Again, aside from the initial randomization and retrospective data collection and analysis, all of the above would have occurred irrespective of this research protocol.

Official Title
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Virtual Visits at Brigham and Women's Hospital: A Randomized Controlled Trial

Conditions
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Heart Failure, Hypertension, Diabetes Mellitus, Stroke, BPH, Hyperlipidemia

Intervention / Treatment
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* Other: Virtual Visit


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinician whose department is chosen for virtual visit rollout Exclusion Criteria: Clinician who saw on average fewer than 20 patients monthly over the past 6 months Clinician who opts out of virtual visits

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Clinicians slated for virtual visit rollout will be randomized (stratified by department) to either receive immediate virtual visit on-boarding (intervention arm) or delayed (3-months later) virtual visit on-boarding (control arm).
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>If enrolled in the intervention arm, the following steps will occur: The Brigham Health Virtual Care team will work with the clinician toward immediate on-boarding (software training, hardware setup, technical support) as per their usual process. The clinician will schedule virtual visits as s/he and/or her/his department see fit. Virtual visits occur on an already-in-use Partners- and Brigham-approved video platform. | Other: Virtual Visit<br>* Clinicians will have a synchronous video visit with their patients.<br>|
| No Intervention: Control<br>If enrolled in the control arm, the following steps will occur: Three months from the time of the follow-up email, the Brigham Health Virtual Care team will work with the clinician toward immediate on-boarding (software training, hardware setup, technical support) as per their usual process. The clinician will schedule virtual visits as s/he and/or her/his department see fit. Virtual visits occur on an already-in-use Partners- and Brigham-approved video platform. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Days until third available appointment | Number of days until the third available routine appointment, obtained at 12 o'clock each Friday (embargoed appointments not included). The mean of all of the weeks is a clinician's average number of days until the third available routine appointment. | Through study completion, an average of 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Days until first available appointment | Number of days until the next available routine appointment, obtained at 12 o'clock each Friday (embargoed appointments not included). The mean of all of the weeks is a clinician's average number of days until the next available routine appointment. | Through study completion, an average of 6 months | 
| Future capacity: percentage of open appointment slots | Percentage of appointment slots that are open and available for booking patients over the next four weeks, obtained at 12 o'clock each Friday (embargoed appointments not included). The mean of all of the weeks is a clinician's future capacity. | Through study completion, an average of 6 months | 
| Frequency of visits with the usual provider of care | Ratio of the number of visits to the most frequently seen provider to the total number of visits to all providers obtained each month. The mean of all of the months is a clinician's ratio. | Through study completion, an average of 6 months | 
| Continuity of care index | The number of visits to each individual physician divided by the total number of visits the patient had overall obtained each month. The mean of all of the months is the continuity of care index | Through study completion, an average of 6 months | 
| No show rate | Ratio of the number of no-show visits to total visit slots obtained each week. The mean of all of the weeks is a clinician's no show rate. | Through study completion, an average of 6 months | 
| Visit time | In-person: face time with patient per pertinent EHR fields, obtained each week. The mean of all of the weeks is a clinician's visit time. Virtual: enter virtual waiting room to video stops, obtained each week. The mean of all of the weeks is a clinician's visit time. | Through study completion, an average of 6 months | 
| Clinician volume per hour | Patients seen per hour, calculated at the end of the study. | Through study completion, an average of 6 months | 
| Clinician volume per day | Patients seen per day, all calculated at the end of the study. | Through study completion, an average of 6 months | 
| Clinician volume per month | Patients seen per month, all calculated at the end of the study. | Through study completion, an average of 6 months | 
| Clinician volume per 6 months | Patients seen per 6 months, all calculated at the end of the study. | Through study completion, an average of 6 months | 
| Slot utilization | Ratio of used slots to total slots, obtained each week. The mean of all of the weeks is a clinician's slot utilization. | Through study completion, an average of 6 months | 
| Number of primary care visits | Number of primary care visits | Through study completion, an average of 6 months | 
| Number of specialist visits | Number of specialist visits | Through study completion, an average of 6 months | 
| Number of emergency department visits | Number of emergency department visits | Through study completion, an average of 6 months | 
| Number of inpatient admissions | Number of inpatient admissions | Through study completion, an average of 6 months | 
| Number of imaging studies | Number of imaging studies ordered | Through study completion, an average of 6 months | 
| Number of labs ordered | Number of laboratory studies ordered | Through study completion, an average of 6 months | 
| Number of medications prescribed | Number of medications prescribed | Through study completion, an average of 6 months | 
| Patient Experience | Brigham Health Virtual Care team survey sent to participating patients | Sent electronically within 1 week of the in-person or virtual visit | 
| Revenue from virtual or in-person visit | Revenue garnered by an individual clinician for her/his clinical activity, calculated per hour and per 6 months (denominator: total clinical hours worked). | Through study completion, an average of 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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virtual visit, telemedicine, virtual care