The research utilizes the Telehealth Expansion Framework for investigating telehealth adoption within nursing homes before-and-after the expansion of federal regulation.

2

Kelly Nhu Tran

Walden University

Final Project Part 1

Due date: 05/04/2025

Author/ Date	Theoretical/ Conceptual Framework	Research Question(s)/ Hypotheses	Methodology	Analysis & Results	Conclusions	Implications for Future research	Implications For practice	Empirical Research (Yes or No)
Alexander et al.(2020)	The research utilizes the Telehealth Expansion Framework for investigating telehealth adoption within nursing homes before-and-after the expansion of federal regulation. This expansion occurred during the COVID-19 pandemic and assesses facets of telehealth on access to and quality of care for long-term settings.	Does telehealth expansion actually result in more extensive telehealth use in nursing homes? What organizational characteristics (for example, size, geographical location, and ownership) are related with telehealth use in nursing homes?	Data for this quantitative survey were collected from 664 U.S. nursing homes with regard to their telehealth utilization before and after March 2020, when the telehealth regulations were expanded. Logistic regression was used to analyze the data.	The findings of the investigation stated that telehealth application increased substantially as a result of the extended facility, particularly within larger metropolitan areas as well as non-profit facilities.. The data indicated that 11.24 times more nursing homes incorporated telehealth for resident evaluations with respect to those who had adopted it prior to expansion.	Though telehealth adoption rates increased tremendously in nursing homes, there still remain disparities based on facility characteristics, particularly with respect to more relaxed regulations.	Research needs to more aggressively embrace studies targeting the disposition of telehealth technologies in nursing homes, particularly the small and rural ones.	Telehealth improves accessibility and reduces isolation in nursing homes, but more resources and support are warranted for smaller facilities that need to fully embrace telehealth concepts.
(Esper et al., 2020)	The article applies the Hub-and-Spoke Model and Lean Management Principles to examine the rapid implementation of telehealth services. The framework emphasizes the importance of leadership in scaling up telehealth and assuring quality care.	What were some of the strategies that healthcare systems implemented for the rapid installation of telehealth services which would support continuous patient care throughout the COVID-19 pandemic?	The study investigated the quantitative data gotten from the implementation process of telehealth at Emory Healthcare including training and certification as well as its deployment across various specialties.	The implementation process recorded 64,290 telehealth visits in just 8 weeks, with 2,374 clinicians trained. Results indicated that a structured and organized approach that involved administrative support, training, and Lean principles was able to quickly scale up the intervention.	Rapid telehealth implementation is achievable with a structured framework. Healthcare systems with prior investments in telehealth infrastructure can expand these services quickly in a crisis.	There is, however, a decidedly high requirement for further research to be undertaken regarding sustainability for quick telehealth deployments and how various healthcare models would impact the possibilities of scaling up telehealth.	Healthcare systems should focus on building telehealth infrastructure before a crisis to respond effectively in emergencies.

Part 2: The Synthesis and the Decision Proposed Paper

Central Healthcare System (CHS) finds itself at a pivotal moment in its launch scheme to contemplate whether telehealth services should continue above and beyond the pandemic. The health systems’ telehealth capability quickly began during the pandemic to allow care without compromising exposure of any kind, as well as preventive measures for patients and healthcare personnel. Thus, it was a matter of a rapid deployment in response to the crisis. It also became a long-term mitigation strategy initiated by the increasing demand for remote healthcare services. With the easing of restrictions and hybrids of in-person visits, administrators now must find the appropriate balance and reason as to why telehealth should remain embedded within the services within the system. This decision could be consequential toward determining patient access to care, operational efficiency, and future opportunities of healthcare delivery in the region.

For a fair analysis, CHS has amassed a great, resourceful data pool supporting its decision-making process, such as surveys involving patients and providers and focus groups involving members across the number of health facilities interviewed. All these various data sources give an idea of telehealth’s perceived positive and negative aspects. Strengthening one way or another, the decision requires a strong synthesis and discussion of this data vis-à-vis pertinent scholarly literature. Comparison between the findings of CHS and academic studies will lead to a better understanding of the broader implications of effectiveness, cost efficiency, and consequences on patient outcomes of telehealth expansion. This paper centers on synthesizing reports of the data through CHS and surveying relevant research to produce data-rich recommendations for future telehealth services in the system.

CHS Data Summaries

Findings from the survey and focus groups on CHS telehealth are invaluable to patient and provider perception. Overall satisfaction with telehealth was reported positively by patients and providers, with some extreme dissimilarities, according to the survey. Patients, particularly those aged 65 and older, rated ease of use for telehealth platforms lower than the providers’ rating. Overall, telehealth services were rated positively, with slightly lowered scores on effectiveness for surgical patients and providers. Focus groups indicated that telehealth was perceived as a greater convenience, saving time, especially since the patient does not travel for appointments. Limitations of telehealth would include an inability to perform an in-person physical exam, as well as technology gaps that hamper older patients.

The data collected from CHS’s telehealth surveys and focus groups show that patients and providers are very accepting and satisfied with telehealth services. However, some serious concerns centered on the quality of care delivered in a virtual context. Telehealth takes on a more helpful and effective characterization in the eyes of the patients; however, concerning specialties where physical examinations would play an important role, such as surgery, there were soft hesitations regarding telehealth’s ability to capture the subtleties of conditions. One such example would be the assertion made by surgical patients and providers that telehealth cannot provide the deep assessment necessary for in-person consultation, including physical examination, tissue palpation, and movement analysis. Further, unlike their younger counterparts, older patients, especially those 65 and older, often faced technological barriers to accessing the service. Therefore, these factors show telehealth is most effective in follow-up visits, consultations, and chronic condition management, but cannot substitute the full care provided by traditional face-to-face visits that require deep physical examinations.

Synthesis of the Literature

As shown by the results, Esper et al. (2020) provided a clear framework for understanding how healthcare systems would rapidly build telehealth services as an emergency response. A rapid telehealth deployment through Emory Healthcare’s hub-and-spoke model was central to the system’s success. This model focused on ensuring that small teams, or spokes, were directed and supported by a central leadership hub for consistency of training, certification, and standardized processes across multiple facilities. The principles of lean management stress maximizing efficiency while minimizing waste, thereby allowing for optimizing processes and training that enabled the smooth and effective functioning of telehealth. A much-extended model is likely to prosper in larger healthcare systems such as Emory Healthcare, which taught from this foundational telehealth infrastructure to facilitate urgent service expansion during a crisis. It is worth noting that a similar model could ensure smooth scalability for CHS, already engaged in telehealth services. Additionally, positive patient and provider perspectives reflected in the surveys conducted by CHS are corroborated by the conclusion of Esper et al. regarding the impacts of telehealth on care continuity, providing extended healthcare access during interruptions such as pandemics.

The barriers and the windows of opportunity for telehealth expansion into nursing homes during the COVID-19 pandemic are discussed by Alexander et al. (2020), showing the impact of facility size and geography on the acceptance of telehealth. The study concluded that the larger and metropolitan nursing homes had a greater chance of being able to implement telehealth successfully. On the contrary, smaller or rural facilities performed poorly in this regard. The implications of these findings are important in the context of CHS, as they suggest that telehealth is more likely to be implemented successfully in facilities with resources to maintain strong technical infrastructure and staff training. In reality, while it is easier for larger health systems to adopt telehealth as they are endowed with access to those resources, it will be tougher for smaller facilities, including rural ones, to do that without these resources. This calls for further investment in technical infrastructure and staff training to maximize implementation of the telehealth system in all CHS facilities, particularly the underserved. With such measures in place, CHS will ensure that telehealth opportunities are maximized and equalized for all facilities, even for those in rural areas which might otherwise lag behind in telehealth adoption with the resources.

Evidence Significance

In their summative study about telehealth, both acquired by some leadership and a proper undergirding framework as two very vital prerequisites to telehealth implementation, Esper et.al. (2020) postulated further to highlight how critical standardization is in clear training modules and standardized process for successful and speedy telehealth deployment by Emory Healthcare during the current COVID pandemic. Providers across multiple specializations were trained and prepared for telehealth service. CHS survey results here show that patients and providers appreciated the well-structured telehealth approach, particularly clear and easy scheduling with quite a simple, streamlined access. In order for telehealth to survive, a well-structured model with strong training, clear operating procedures, and a committed leadership is necessary to implement successful telehealth practices into different health environments.

According to Alexander et al. (2020), facility attributes-like dimension and location-are even a more salient concern in building up telehealth. Large facilities within metropolitan areas adopt and start telehealth services easily because of developed resources, better infrastructure, and higher patient volumes. In contrast, small facilities and locales resembling rural areas are having a hard scale in telehealth due to deficient technology resources and challenges in securing adequate training and support. With these variations in mind, it can be assumed that CHS would likely have to adapt some of the other areas of its telehealth scaling strategy to deal with the discrepancies involved, namely funding technology infrastructure and training professional staff at its larger versus rural clinics. By guaranteeing the needed resources and support at those facilities, CHS will keep telehealth expansion consistent across all its sites for maximum effectiveness.

Additional Data Needs

While the CHS surveys and focus groups provide a solid basis for understanding patient and provider perceptions of telehealth, further comprehensive data are needed to arrive at a fully informed decision about telehealth expansion. One important issue for further investigation is comparing patient outcomes between telehealth consultations and traditional in-person visits. If telehealth offers similar care for many conditions, particularly chronic disease management or mental health services, it will shed light on its clinical impact. The collection of such data can assure that telehealth services are not simply an expedient option but an option for quality care. Furthermore, a cost-benefit analysis would help CHS understand the financial implications of telehealth service expansion. This data can determine whether investing in telehealth infrastructure and staffing would be financially sustainable in the longer term in terms of reimbursement rates, operational costs, and potential savings incurred through lower in-person visits.

Moreover, CHS should gather data on technological hurdles facing patients, particularly those who encountered difficulties with telehealth platforms while being seen for their visits. Such information could be key in defining the challenges facing patients at a more specific level, such as barriers with technological access, understanding the platforms, or limited internet connectivity, especially within the older population and in rural settings. This identification and rectification of said barriers could lead CHS to establish a support system program suited for those specific populations, with more ease-of-use technologies, further training of patients, or better internet access. This would ultimately enhance CHS’s ability to engage patients with these telehealth services and ensure that such platforms are accessible to all patient populations while improving the quality of care delivered through telehealth.

Decision Support

i. Expand Telehealth Gradually

Gradually introducing telehealth services will reduce the risk of full implementation at one go; the first steps should concentrate on specialties that do not require in-person physical examination during medical visits, such as mental health and chronic conditions management. Such specialties are known for understanding telehealth, as they depend on consultation and follow-up care rather than physical assessment. These initial steps can ensure the effective implementation of telehealth within a limited, controlled, and lower-risk area. This also allows time to work out any technical or logistical glitches, gather feedback, and improve before extending telehealth to specialties that require physical examination.

ii. Invest in Technology Infrastructure

Telehealth services can be offered at their best in all CHS facilities only if efforts are made to get the technology infrastructure for each place, especially those in rural areas and smaller clinics. Hardware and software need to be improved, internet access must be dependable, and health care providers should be given adequate resources for virtual consultations with patients. Training of the patients and the healthcare staff also needs to take place. The training should include the use of telehealth platforms and troubleshooting common issues while ensuring that patient privacy and data security are maintained. Having every personnel well conversed with telehealth technology minimizes technical difficulty, enhances patient satisfaction, and optimizes care delivery.

iii. Evaluation of the Cost-Benefit

CHS would need comprehensive cost-benefit analyses before executing a long-term investment in enlarging telehealth to ascertain its financial viability. The analysis should account for savings realized through reduced travel, reduced overhead and increased efficiency of operations. It should also evaluate the reimbursement schedules for telehealth services due to the changes in reimbursement policies made by Medicare and other insurance providers. These will help establish the financial implications of the expansion and whether there will be a positive return on investment for the intended outlay. In addition, a cost-benefit analysis would also be instrumental in identifying other areas that may require increased resources, such as training or facilities, to ensure sustainability, for a closer telehealth relationship.

Conclusions

The development of telehealth services in CHS has crucial benefits for patients and organizations. Some of it could include access to medical care, especially for low-income people in underserved rural areas, or travel. Patients with chronic illnesses and impaired mobility would experience less burden because of a lack of travel. Telehealth benefits continued delivery of medical assistance during interruptions like the COVID-19 crisis. In this case, it allows for the continuity of care during emergencies in CHS. However, this implementation must be very carefully planned. That includes investing in a strong technology infrastructure, ensuring every site, especially rural sites, has the necessary telehealth tool, and providing support and training for both consumers and healthcare professionals for proper use. The ongoing data collection and evaluation will be necessary to measure telehealth’s results regarding the quality of care and patient satisfaction.

References

Alexander, G. L., Powell, K. R., & Deroche, C. B. (2021). An evaluation of telehealth expansion in US nursing homes.  Journal of the American Medical Informatics Association,  28(2), 342-348.

Esper, G. J., Sweeney, R. L., Winchell, E., Duffell, J. M., Kier, S. C., Lukens, H. W., & Krupinski, E. A. (2020). Rapid systemwide implementation of outpatient telehealth in response to the COVID-19 pandemic.  Journal of Healthcare Management,  65(6), 443-452.

,

In Part 1 of your Final Project, you used the Data-Driven Decision-Making Framework to collect, analyze, and synthesize data to inform a Central Healthcare System (CHS) decision about a potential telehealth expansion. Now, it is time for CHS leaders to make a decision and plan their next steps. 

In this second part of your Final Project, you will focus on the decision itself and the steps that follow in the cyclical Data-Driven Decision-Making Framework, which ensure that leaders continue to use evidence to drive implementation and make necessary adjustments. How will this part of the decision-making process differ from your analysis and synthesis? What strategies could you use to effectively communicate your findings and recommendations to a team of Central Healthcare System administrators? Your analysis and synthesis in Part 1 were fairly detailed, but for this part of the Final Project, you may want to incorporate shorter summaries and visual aids to convey the most critical information that CHS leaders need to develop implementation and surveillance plans.

For this second portion of your Final Project, you will apply prioritization strategies to the data you synthesized in Part 1 to support and justify a decision about CHS’s telehealth expansion. You will then develop a slide presentation for CHS administrators that outlines the data-driven decision and explains plans to implement the decision, evaluate the decision’s impact, and communicate results with stakeholders.

Prepare a 14-slide presentation for the administration at Central Healthcare System that focuses on the implementation and impact of the decision. Use the notes section on each slide to provide further context and explanation to the content of the slides. Within your presentation, include the following:

· Slide 1: Title Slide

· Slide 2: Objectives for the presentation

· Slides 3 and 4: Prioritize the data that you synthesized in the first part of the Final Project to support a decision.

· Slide 5: Provide a clear explanation of the data-driven decision that was made.

· Slides 6 and 7: Briefly summarize the data and information to justify the decision.

· Slides 8 and 9: Explain how you plan to implement the decision.

· Slides 10 and 11: Explain how you plan to measure the impact of the decision.

· Slide 12: Explain your plan for communicating this information to relevant stakeholders.

· Slide 13: Explain how you might make necessary adjustments to the decision.

· Slide 14: References

Note: The number of slides given are a recommendation, but you may need additional slides to adequately present the information. You may go over 14 slides, but do not exceed 18 in your final submission.

Include visual elements (charts, tables, etc.) where appropriate to help support your decision and justification. Slides should be clear, visually appealing, and in line with best practices for a presentation (see Learning Resources for more information).

Ensure that you incorporate feedback from your Final Project submission into this presentation.