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CC BY-NC-ND 4.0 · Appl Clin Inform 2022; 13(01): 230-241
DOI: 10.1055/s-0042-1742627
Research Article

Associations of Telehealth Care Delivery with Pediatric Health Care Provider Well-Being

Richelle deMayo
1   Division of Clinical Informatics, Connecticut Children's Medical Center, Hartford, Connecticut, United States
2   Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Hartford, Connecticut, United States
3   Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, United States
,
Yungui Huang
4   Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, United States
,
En-Ju D. Lin
4   Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Jennifer A. Lee
5   Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio, United States
6   Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, United States
7   Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, United States
,
Andrew Heggland
1   Division of Clinical Informatics, Connecticut Children's Medical Center, Hartford, Connecticut, United States
3   Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, United States
8   Division of Pediatric Emergency Medicine, Connecticut Children's Medical Center, Hartford, Connecticut, United States
,
Jane Im
1   Division of Clinical Informatics, Connecticut Children's Medical Center, Hartford, Connecticut, United States
3   Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, United States
9   Division of Pediatric Hospital Medicine, Connecticut Children's Medical Center, Hartford, Connecticut, United States
,
Christopher Grindle
1   Division of Clinical Informatics, Connecticut Children's Medical Center, Hartford, Connecticut, United States
10   Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, United States
11   Division of Otolaryngology, Connecticut Children's Medical Center, Hartford, Connecticut, United States
,
Aarti Chandawarkar
5   Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio, United States
7   Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, United States
› Author Affiliations Funding None.
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Abstract

Background The rapid, large-scale deployment of new health technologies can introduce challenges to clinicians who are already under stress. The novel coronavirus disease 19 (COVID-19) pandemic transformed health care in the United States to include a telehealth model of care delivery. Clarifying paths through which telehealth technology use is associated with change in provider well-being and interest in sustaining virtual care delivery can inform planning and optimization efforts.

Objective This study aimed to characterize provider-reported changes in well-being and daily work associated with the pandemic-accelerated expansion of telehealth and assess the relationship of provider perceptions of telehealth effectiveness, efficiency, and work–life balance with desire for future telehealth.

Methods A cross-sectional survey study was conducted October through November 2020, 6 months after the outbreak of COVID-19 at three children's hospitals. Factor analysis and structural equation modeling (SEM) were used to examine telehealth factors associated with reported change in well-being and desire for future telehealth.

Results A total of 947 nontrainee physicians, advanced practice providers, and psychologists were surveyed. Of them, 502 (53.0%) providers responded and 467 (49.3%) met inclusion criteria of telehealth use during the study period. Of these, 325 (69.6%) were female, 301 (65.6%) were physicians, and 220 (47.1%) were medical subspecialists. Providers were 4.77 times as likely (95% confidence interval [CI]: 3.29–7.06) to report improved versus worsened well-being associated with telehealth. Also, 95.5% of providers (95% CI: 93.2–97.2%) wish to continue performing telehealth postpandemic. Our model explains 66% of the variance in telehealth-attributed provider well-being and 59% of the variance for future telehealth preference and suggests telehealth resources significantly influence provider-perceived telehealth care effectiveness which in turn significantly influences provider well-being and desire to perform telehealth.

Conclusion Telehealth has potential to promote provider well-being; telehealth-related changes in provider well-being are associated with both provider-perceived effectiveness of telemedicine for patients and adequacy of telehealth resources.

Keywords

telemedicine and telehealth - burnout, professional - efficiency - clinical effectiveness - personal satisfaction

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the Institutional Review Boards of all participating organizations: Connecticut Children's (registration no.: IRB00000703), Nationwide Children's Hospital (registration no.: IRB00000568), and East Tennessee Children's Hospital (registration no.: IRB00002221).




Publication History

Received: 10 July 2021

Accepted: 14 December 2021

Article published online:
16 February 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Mann DM, Chen J, Chunara R, Testa PA, Nov O. COVID-19 transforms health care through telemedicine: evidence from the field. J Am Med Inform Assoc 2020; 27 (07) 1132-1135
    CrossrefPubMedGoogle Scholar
  • 2 Wosik J, Fudim M, Cameron B. et al. Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc 2020; 27 (06) 957-962
    CrossrefPubMedGoogle Scholar
  • 3 Eschenroeder HC, Manzione LC, Adler-Milstein J. et al. Associations of physician burnout with organizational electronic health record support and after-hours charting. J Am Med Inform Assoc 2021; 28 (05) 960-966
    CrossrefPubMedGoogle Scholar
  • 4 Friedberg MW, Chen PG, Van Busum KR. et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Rand Health Q 2014; 3 (04) 1
    PubMedGoogle Scholar
  • 5 Kroth PJ, Morioka-Douglas N, Veres S. et al. Association of electronic health record design and use factors with clinician stress and burnout. JAMA Netw Open 2019; 2 (08) e199609
    Google Scholar
  • 6 Gardner RL, Cooper E, Haskell J. et al. Physician stress and burnout: the impact of health information technology. J Am Med Inform Assoc 2019; 26 (02) 106-114
    CrossrefPubMedGoogle Scholar
  • 7 Wu DTY, Xu C, Kim A, Bindhu S, Mah KE, Eckman MH. A scoping review of health information technology in clinician burnout. Appl Clin Inform 2021; 12 (03) 597-620
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Hartzband P, Groopman J. Physician burnout, interrupted. N Engl J Med 2020; 382 (26) 2485-2487
    CrossrefPubMedGoogle Scholar
  • 9 Mehta S, Machado F, Kwizera A. et al. COVID-19: a heavy toll on health-care workers. Lancet Respir Med 2021; 9 (03) 226-228
    CrossrefPubMedGoogle Scholar
  • 10 Reliford A, Adebanjo B. Use of telepsychiatry in pediatric emergency room to decrease length of stay for psychiatric patients, improve resident on-call burden, and reduce factors related to physician burnout. Telemed J E Health 2019; 25 (09) 828-832
    CrossrefPubMedGoogle Scholar
  • 11 Chu-Weininger MY, Wueste L, Lucke JF, Weavind L, Mazabob J, Thomas EJ. The impact of a tele-ICU on provider attitudes about teamwork and safety climate. Qual Saf Health Care 2010; 19 (06) e39
    PubMedGoogle Scholar
  • 12 Kuo KM, Talley PC, Lee CM, Yen YC. The influence of telemedicine experience on physicians' perceptions regarding adoption. Telemed J E Health 2015; 21 (05) 388-394
    CrossrefPubMedGoogle Scholar
  • 13 Sauers-Ford HS, Hamline MY, Gosdin MM. et al. Acceptability, usability, and effectiveness: a qualitative study evaluating a pediatric telemedicine program. Acad Emerg Med 2019; 26 (09) 1022-1033
    CrossrefPubMedGoogle Scholar
  • 14 Brigham T, Barden C, Dopp AL. et al. A journey to construct an all-encompassing conceptual model of factors affecting clinician well-being and resilience. Accessed January 11, 2022: https://nam.edu/wp-content/uploads/2018/01/Journey-to-Construct-Conceptual-Model.pdf
    PubMedGoogle Scholar
  • 15 Doarn CR, Pruitt S, Jacobs J. et al. Federal efforts to define and advance telehealth–a work in progress. Telemed J E Health 2014; 20 (05) 409-418
    CrossrefPubMedGoogle Scholar
  • 16 Weaver MS, Lukowski J, Wichman B, Navaneethan H, Fisher AL, Neumann ML. Human connection and technology connectivity: a systematic review of available telehealth survey instruments. J Pain Symptom Manage 2021; 61 (05) 1042-1051.e2
    CrossrefPubMedGoogle Scholar
  • 17 deMayo R, Heggland A, Grindle C. et al. Pediatric telemedicine work and well-being survey. Accessed May 31, 2021: https://is.gd/peditelemed
    PubMedGoogle Scholar
  • 18 Arch collaborative example survey. Available at https://klasresearch.com/images/pages/usability-studies/base-emr-experience-survey.pdf
    PubMedGoogle Scholar
  • 19 Sisk B, Alexander J, Bodnar C. et al. Pediatrician attitudes toward and experiences with telehealth use: results from a national survey. Acad Pediatr 2020; 20 (05) 628-635
    CrossrefPubMedGoogle Scholar
  • 20 Yip MP, Chang AM, Chan J, MacKenzie AE. Development of the Telemedicine Satisfaction Questionnaire to evaluate patient satisfaction with telemedicine: a preliminary study. J Telemed Telecare 2003; 9 (01) 46-50
    CrossrefPubMedGoogle Scholar
  • 21 Parmanto B, Lewis Jr. AN, Graham KM, Bertolet MH. Development of the Telehealth Usability Questionnaire (TUQ). Int J Telerehabil 2016; 8 (01) 3-10
    CrossrefPubMedGoogle Scholar
  • 22 Bakken S, Grullon-Figueroa L, Izquierdo R. et al; IDEATel Consortium. Development, validation, and use of English and Spanish versions of the telemedicine satisfaction and usefulness questionnaire. J Am Med Inform Assoc 2006; 13 (06) 660-667
    CrossrefPubMedGoogle Scholar
  • 23 Dolan ED, Mohr D, Lempa M. et al. Using a single item to measure burnout in primary care staff: a psychometric evaluation. J Gen Intern Med 2015; 30 (05) 582-587
    CrossrefPubMedGoogle Scholar
  • 24 random.polychor.pa: A Parallel Analysis with Polychoric Correlation Matrices. Accessed May 31, 2021: https://CRAN.Rproject.org/package=polycor
    PubMedGoogle Scholar
  • 25 Revelle W. psych: Procedures for Psychological, Psychometric, and Personality Research. R package version 2.1.3. Northwestern University:. 2021 Accessed May 31, 2021 at: https://CRAN.R-project.org/package=psych
    PubMedGoogle Scholar
  • 26 Rosseel Y. lavaan: An R Package for Structural Equation Modeling. J Stat Softw 2012; 48 (02) 1-36
    CrossrefPubMedGoogle Scholar
  • 27 West CP, Dyrbye LN, Sloan JA, Shanafelt TD. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. J Gen Intern Med 2009; 24 (12) 1318-1321
    CrossrefPubMedGoogle Scholar
  • 28 Brady KJS, Ni P, Carlasare L. et al. Establishing crosswalks between common measures of burnout in US physicians. J Gen Intern Med 2021; DOI: 10.1007/s11606-021-06661-4.
    CrossrefPubMedGoogle Scholar
  • 29 Hair Jr. J, Sarstedt M, Hopkins LG, Kuppelwieser V. Partial least squares structural equation modeling (PLS-SEM). Eur Bus Rev 2014; 26 (02) 106-121
    CrossrefPubMedGoogle Scholar
  • 30 Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Mark Res 1981; 18 (01) 39-50
    CrossrefPubMedGoogle Scholar
  • 31 Rotenstein LS, Torre M, Ramos MA. et al. Prevalence of burnout among physicians: a systematic review. JAMA 2018; 320 (11) 1131-1150
    CrossrefPubMedGoogle Scholar
  • 32 West CP, Dyrbye LN, Satele DV, Sloan JA, Shanafelt TD. Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment. J Gen Intern Med 2012; 27 (11) 1445-1452
    CrossrefPubMedGoogle Scholar
  • 33 Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB. The job demands-resources model of burnout. J Appl Psychol 2001; 86 (03) 499-512
    CrossrefPubMedGoogle Scholar
  • 34 AAMC. Telehealth competencies across the learning continuum. Accessed January 11, 2022 at: https://store.aamc.org/downloadable/download/sample/sample_id/412/
    PubMedGoogle Scholar