Using Telementoring to Share Best Practices on <scp>COVID</scp> ‐19 in <scp>Post‐Acute</scp> and <scp>Long‐Term</scp> Care Facilities

Abstract

Post-acute and long-term care facilities, known as skilled nursing facilities (SNFs), are high risk for severe COVID-19 outbreaks, have potential for presymptomatic/asymptomatic transmission, and may have poor outcomes due to severity of disease in older adults.1, 2 Facilities must keep up-to-date with information and adapt to rapidly changing practices. The Project Extension for Community Healthcare Outcomes (ECHO) model has been used extensively in urban and rural settings to provide telementoring to healthcare workers in a variety of topics and has shown promise in sharing best practices with SNF staff via telementoring.3, 4 The ECHO model employs didactic training and case discussion facilitated by academic medical experts at a remote location, connecting to registered trainees virtually through a web-based videoconferencing platform. Considering social distancing efforts to curb the COVID-19 pandemic, telementoring training programs have distinct advantages as a mode of specialized education delivery. Based on the need of SNF administrators, providers, and staff for up-to-date COVID-19 information, we designed an ECHO telementoring series entitled COVID-19 in Skilled Nursing & Long-Term Care Facilities (COVID-19 SNF). This report shares our experience in utilizing ECHO as an educational platform with SNFs throughout the state of Illinois to rapidly respond to evolving changes in the COVID-19 pandemic. Our center is home to ECHO-Chicago, which hosts over 20 unique subject area ECHO series, including Geriatrics for SNFs and Geriatrics for Primary Care. Based on our previous experiences and infrastructure, we were able to roll out a novel six-session series dedicated to COVID-19 in SNFs in coordination with a Health Resources and Services Administration–funded Geriatrics Workforce Enhancement Program. Timeline from series inception to first educational session was 5 weeks. Planning involved two virtual meetings; curriculum development by geriatric medicine fellows, attendings, and Illinois Department of Public Health (IDPH); and recruitment and enrollment of participants by ECHO staff. Given the rapidly evolving nature of COVID-19 in SNFs and input from IDPH, six sessions were held biweekly for 1-hour duration to share timely information. Each session featured a 20-minute didactic, a case discussion, and a question and answer session with our subject matter expert (SME) team. The Zoom videoconferencing platform was used by participants to join remotely at no cost. The multidisciplinary SME team consisted of at least four academic geriatricians, one infectious disease physician, and one nurse educator with experience in nursing home care. The sessions included: (1) Admitting/Isolation; (2) Personal Protective Equipment/Physical Environment; (3) Healthcare Worker Safety; (4) Advance Care Planning/End-of-Life Care; (5) Telemedicine/Communication; and (6) COVID-19 Therapies. Cases presented centered on issues of diagnosis, communication, goals of care, hospice, and treatment/therapies related to COVID-19. Self-selected participants were enrolled through recruitment efforts by SNF leadership and advertising by the IDPH. Data collection was approved by the institutional review board, and consent was waived as all identifiers were removed. Demographics were collected at registration, attendance was tracked, and a postsurvey was sent following the series collecting open-ended feedback about the program, and self-reported changes in practice and self-efficacy. During the final moments of each session, two polling questions were asked in real time: (1) “Compared to before today's session, I feel ______ in control when it comes to addressing COVID in my professional capacity.” and (2) “Please rate the relevance of today's ECHO content to your professional performance (both rated on a 5-point Likert scale).” Ninety-five unique participants representing a broad range of disciplines, including administrators, attorney, nurses, nurse practitioners, and physicians, participated in the entire ECHO series. Attendance ranged from 25 to 47 participants per session. Polling questions conducted showed a majority of respondents (64%–93%) felt more or much more in control when it came to addressing COVID-19 in their professional capacity. Aggregate data across sessions found 69% of respondents felt that the series contained new and relevant information with definite or potential impact on their professional performance (Figure 1). Postsession feedback revealed that participants enjoyed the case studies and the content of the didactics. One participant noted “[I] appreciated hearing from the panel on their experiences and their opinions on new info(sic) and research as it becomes available.” When commenting on workplace change, one participant stated, “Yes, we have implemented some of the things we learned and expanded on others. Thank you for putting this together. The nursing homes are being hit so hard by the media right now. It is good to have many resources.” While another commented, “I feel better equipped to handle them [COVID patients] as a result of hearing from others who have been caring for them for several weeks already.” COVID-19 SNF training via ECHO is a novel way to engage and educate providers during a global pandemic. Our model was well received by participants as an effective mechanism to rapidly deliver up-to-date information. By utilizing videoconferencing technology, we were able to bring together providers across our state during the shelter in place to engage in shared learning with experts. Leveraging of preexisting ECHO infrastructure to rapidly host, organize, and establish a curriculum with SMEs contributed to program success. Although we had fairly consistent attendance for all sessions, response rates to polling questions were variable; additionally, the attendance might have been reduced by competing priorities during the pandemic. Additionally, we found that participants were occasionally hesitant to share their thoughts during the case discussion. This might be because they were reluctant to share what they did not know or to provide details of how the pandemic was affecting their facilities. To address this, we allowed for anonymous submissions of questions before each session. Given the broad range of participants in the series, we also needed to ensure our sessions covered a range of topics that were applicable to learners in different roles. Given the increasing use of ECHO programs, this type of series has potential to be replicated across the world with a format that can easily be adapted for future epidemics. COVID-19 SNF is a novel approach to provide telementoring in response to the COVID-19 pandemic. This series was rapidly developed, was feasible to implement, and overcame limitations of social distancing. Utilizing videoconferencing technology allowed participants to share best practices in response to COVID-19. Adoption and sustainability for other institutions with ECHO programs is feasible, and these programs could easily be offered to participants at institutions without ECHO programs via videoconferencing. Future work is needed to study this model's impact on patient care and clinical outcomes. This publication was made possible in part by Grant U1QHP28728 from the Health Resources and Services Administration, an operating division of the U.S. Department of Health and Human Services, the COVID T1M grant T1MHP39062, UChicago Medicine's Urban Health Initiative, and the United Health Group Foundation. The authors have no competing interests of conflicts to declare. L.J.G., K.T., D.J., K.L., J.W., K.J.B., S.S., S.L., and S.S.: Study concept and design. J.G., K.M., D.J., and K.L.: Acquisition of data. J.G., K.M., D.J., K.L., L.J.G., S.L., and K.T.: Analysis and interpretation of data. L.J.G., K.T., and J.G.: Drafting of the manuscript. L.J.G., K.J.B., J.W., S.S., J.G., K.M., K.L., S.S., D.J., S.L., and K.T.: Critical revision of the manuscript for important intellectual content. The funding sources were not involved in the design, analysis, or reporting of the results.