Assuring the Quality of Patient Experience and Outcomes in All-Virtual Nurse Telehealth Programs: A Case Report Illustration

Abstract

There are many approaches to evaluating patient-centered care used by health systems in acute care environments.  Yet a growing proportion of care is happening in remote ways, using telehealth methods for chronic care management programs or health coaching for ‘patients’ living in the community, often rarely seen through in-person visits.  The typical means of assuring patient-centered approaches may be overlooked or inappropriate for assessing the patient experience in telehealth or online venues.  The HealthyLifetime^TM is a community-based, virtual nurse health coaching program for adults with one or more chronic diseases or risk factors.  Our quality assurance program will be described, including an assessment of nurse competency using our six strategies, patient-centeredness and personalized approach to coaching, the quality and completeness of core program activities, and patient outcomes and satisfaction with the program.  We use a patient case study to describe the program's phases and quality assurance process.  While patient satisfaction is an indicator of experience, the quality of the nurse-patient communication dynamic as it relates to the patient’s evolving behavior change and outcome achievement is a critical factor. We developed and validated natural language analysis methods, the Nurse Health Coaching Assessment, to assess the nurse’s use of our six strategies and the patient’s cognitive-behavioral responses – the Indicators of Health Behavior Change – which, combined, assess the quality of nurse-patient communication dynamic.  The case illustrates how the program's total quality assurance approach impacts the nurse’s notes, core program elements, and patient outcomes. Additionally, we discuss the cost and value of the program.