Got WiFi? Exploring the Feasibility of Televisits Among Vulnerable Patients (QI716)

1.Appraise existing literature regarding the implementation of telehealth palliative care, with attention to the patient populations studied.2.Review the methods, findings, and experiences of a pilot telehealth initiative at an urban, safety net palliative care clinic.3.Reflect on lessons learned and formulate approaches to overcoming barriers to completing tele-visits, for vulnerable patients. No-show rates for palliative care clinic visits can be high (21-36% in our setting), frequently due to severe illness, limited transportation, or fatigue from multiple appointments. Telehealth visits may expand access to community-based palliative care for these complex patients. To explore the feasibility of telehealth visits with vulnerable patients in an urban, safety net palliative care clinic. We developed a brief technology access survey to assess patients' access to email and necessary technology, and experience with videoconferencing. The survey was professionally translated into Spanish and Chinese. All patients who completed in-person clinic visits between November 2017 and May 2018 were eligible to participate. Patients who reported access to the necessary technology were offered training to complete televisits. During the study period, 109 patients completed in-person visits. Patients were 26% Latino, 24% Asian/Pacific Islander, 21% African American, and 20% Caucasian; 34% had Limited English Proficiency, and 10% were either marginally housed or homeless. 89 patients (82%) completed the survey. 60 patients (67%) reported access to a smartphone, tablet, or computer and were screened for eligibility. 18 (20%) were deemed ineligible due to significant sensory impairment, cognitive impairment, or limited technology experience. Of the 42 patients eligible for televisits, only 11 (26%) accepted training for televisits. The most common reasons patients declined were preference for in-person visits and lack of WiFi access. 5 patients were scheduled for televisits, and 4 completed visits (4%). The no-show rate for televisits was lower than the general clinic during the same time period (20% vs. 26%). In our setting, likely 10-20% of patients have the access, capability, and interest to attempt televisits. More study is needed to determine whether these patients no-show at lower rates for televisits compared to in-person clinic visits.