National Geriatric Network Rapidly Addresses Trainee Telehealth Needs in Response to COVID-19

Kathryn A. Nearing, PhD; Hillary D. Lum, MD; Stuti Dang, MD; Becky Powers, MD; Jaye McLaren, OT; Megan Gately, OTD; William Hung, MD; Lauren Moo, MD

Disclosures

J Am Geriatr Soc. 2020;68(9):1907-1912. 

In This Article

Abstract and Introduction

Abstract

Background/Objectives: Coronavirus disease 2019 (COVID-19) has pushed many geriatric healthcare providers to attempt video visits for the first time. Although the Veterans Health Administration (VA) is a pioneer in telemedicine, rapid shifts to nearly exclusive use of telehealth for healthcare delivery and changes regarding trainee engagement in telehealth served as the impetus for rapidly assessing telehealth training needs.

Design: National needs assessment (online survey) of associated health trainees and medical fellows affiliated with Geriatric Research Education and Clinical Centers (GRECCs).

Setting: National GRECC network -- 20 VA centers of excellence focused on supporting Veterans as they age. Each GRECC is affiliated with a school of medicine at a major university.

Participants: Trainees (n = 89) representing 12 disciplines.

Results: Two-thirds of participants had received some telehealth training. However, most had never done a video-to-home visit, and, regardless of telehealth experience, they reported low confidence. Based on open-ended questions exploring training needs, educational resources were rapidly developed and disseminated.

Intervention: Within 1 week of the assessment, a nuts-and-bolts guide regarding remote access, technology requirements, video-conferencing platforms, and managing emergencies was sent to the national network of GRECC associate directors for education for dissemination among discipline-specific training directors at their sites. This resource was subsequently submitted to the national VA COVID Strong Practices SharePoint site. An interdisciplinary team of geriatric specialists with extensive video-to-home experience also organized a national webinar that peaked at just over 700 participants. GRECC Connect, a network of geriatric specialty teams funded to improve care access for rural older veterans using telehealth and associated health training programs at each GRECC facilitated rapid development and dissemination of both resources.

Conclusion: We quickly identified and responded to telehealth training needs of geriatrics trainees to optimize care for rural older adults as part of a rapid response to COVID-19. Although the webinar and nuts-and-bolts resources were developed within the VA context, they have demonstrated high demand and broader applicability. Results should continue to inform curriculum development efforts to address telehealth training gaps within and outside the VA.

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has forced the U.S. healthcare system suddenly and dramatically to change how care is delivered. Elective procedures have been postponed, intensive care capacity has been increased, and clinicians have been encouraged to convert as many outpatient visits as possible to telephone or video-to-home formats. Clinical trainees, an important component of many hospital workforces, have been asked to adapt to these changes.

The COVID-19 pandemic has exacerbated the challenges that many older patients face in having access to appropriate care. Clinicians with geriatric specialty training are a scarce resource and generally concentrated in urban medical centers. Given that older patients are at highest risk of poor outcomes with COVID-19 infection, it is imperative that we optimize the care provided remotely for this population. To increase access to care for rural older patients and others for whom a trip to the clinic is challenging, we need to train the next generation of geriatric specialists to use these technological tools effectively with an older population with possible limitations that challenge their ability to use these tools.

Most of today's trainees would be considered digital natives, but it is unclear how well prepared they are to pivot to providing care through telehealth modalities. Geriatric Research Education and Clinical Center (GRECC) Connect, an initiative funded by the Veterans Health Administration (VA) Office of Rural Health that expands access to geriatric specialty care for rural older veterans via telehealth services and education for rural clinicians via national webinars on aging-related topics[1,2] sought to rapidly assess telehealth training gaps near the onset of the COVID-19 crisis. Specifically, we surveyed trainees affiliated with VA geriatric centers of excellence. This article presents the results of the rapid assessment and two educational resources developed in response (Figure 1).

Figure 1.

Visual abstract depicting the capacity of the Geriatric Research Education and Clinical Center (GRECC) Connect network to respond to the COVID-19 crisis.

VA and GRECC as Clinical Education Leaders

The VA provides more geriatric training of healthcare professionals than any other entity nationally,[3,4] with its 20 GRECCs serving as leaders in geriatric-specific interprofessional education. GRECCs are centers of excellence established by Congress in 1975 to improve the health of older veterans.[5] They have three main missions: (1) to build new knowledge through aging-related research, (2) to improve health care through the development of new clinical programs in geriatric specialty care, and (3) to ensure that VA trainees and staff are educated about aging-related issues.[6] Each GRECC is affiliated with a major academic medical center and has an associated health training program that collectively trains more than 800 trainees (interns, externs, residents, and fellows) annually across 15 different disciplines.[7]

GRECC Connect: Using Telehealth to Serve Rural Older Veterans

Recognizing that a higher percentage of veterans in rural areas are older, have multiple chronic conditions,[8] and select the VA for their health care,[9] the VA Office of Rural Health leveraged the capacity of the GRECC network to launch GRECC Connect in 2014. Given extremely limited geriatric resources both within and outside the VA in rural areas,[10] GRECC Connect uses video telehealth and electronic consultation mechanisms to increase access to geriatric specialty care to rural patients. Each of the 15 GRECC Connect hubs supports older veterans in rural areas by providing care through affiliated satellite outpatient clinics and to veterans' homes using a variety of telehealth modalities.[1,2,11]

GRECC Connect: Existing Geriatric Care Infrastructure and Capacity for Rapid Response to COVID-19

GRECC Connect engages interprofessional teams, often including geriatricians, nursing professionals, social workers, pharmacists, psychologists (gero- and neuro-psychologists), and rehabilitation practitioners, as well as administrative support professionals (e.g., telehealth technicians and schedulers).[2] GRECC Connect teams typically integrate medical (e.g., geriatric medicine fellows) and associated health trainees (e.g., pharmacy and optometry). Consequently, some trainees receive unique opportunities for competency-based training in telehealth, modeled by geriatric specialists experienced in telehealth.

However, access to telehealth training varies across the VA system, even among the 20 GRECCs. For those sites with a geriatrics team experienced in using telehealth modalities, such as those affiliated with a GRECC Connect hub, there is variability regarding the extent to which they deliver formal telehealth training. Furthermore, most geriatric video telehealth services have been delivered via "clinical video telehealth," in which a veteran at a satellite outpatient clinic has a video visit with a geriatric specialty care provider or team based at a VA medical center. Therefore, trainees' exposure to telehealth may not have included video-to-home visits. These considerations served as the impetus for conducting a rapid assessment of GRECC-supported trainees' telehealth training needs and dissemination of responsive resources through GRECC Connect. This article highlights the training needs identified through our rapid assessment and resulting educational products to support the unprecedented shift from in-person to video-to-home visits.

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