JMIR Publications

ABSTRACT

Background:

Chronic obstructive pulmonary disease (COPD) affects approximately 16 million Americans and often results in avoidable readmissions due, in part, to medication errors and lack of education. Therefore, we aimed to develop a post-discharge in-home tele-visit intervention to promote medication reconciliation and inhaler education.

Objective:

To design and prototype the components of TELE-TOC (Telehealth Education: Leveraging Electronic Transitions Of Care), a post-discharge in-home tele-visit intervention, and map its workflow to ensure integration into the routine discharge care transition process for patients with COPD.

Methods:

We followed a user-centered design approach across three phases to develop and prototype TELE-TOC. Participants included adult patients hospitalized for COPD exacerbations, their caregivers, clinicians involved in COPD care, and organizational leaders. Data collection methods included semi-structured interviews, system usability scale (SUS) surveys, and cognitive walkthroughs of the TELE-TOC prototype to assess participants’ perceptions on usability and feasibility of TELE-TOC implementation as part of routine COPD discharge care transitions. Qualitative data from Phases 1 and 3 were analyzed using inductive thematic analysis, while Phase 2 employed an inductive-deductive approach guided by the AHRQ-endorsed Care Transitions Framework. Quantitative data were summarized using basic descriptive statistics.

Results:

Participation included 18 patients, 18 clinicians, 8 organizational leaders, and 2 caregivers. Phase 1 identified three interdependent stages of COPD hospital-to-home discharge: inpatient pre-discharge; at-home post-discharge; and outpatient clinic visit post-discharge. Key facilitators to discharge care transitions included the hospital’s “meds-to-beds” program and high patient health literacy, while barriers to discharge included poor timing of education and conflicting patient priorities. Phase 2 delineated the core tele-visit components (e.g., dedicated clinician, medication reconciliation, inhaler use and self-management education) and flexible components (e.g., reminder system, session frequency). Potential implementation enablers included multiple techniques for clinicians to access and support patient education and back-up communication strategies in the event of technical issues. Potential implementation barriers included limited patient technology access and poor technological and health literacy, limited clinician bandwidth for thorough COPD education and medication reconciliation. Phase 3 TELE-TOC prototype walkthroughs showed patients had a positive experience (average SUS score of 97.5/100) –attributed to the benefits of video-conferencing technology for hands-on teaching, and the use of the virtual teach-back method. Identified barriers included varying levels of patient technological literacy, insufficient inhaler education, limited patient understanding of medication lists, and clinician uncertainty around TELE-TOC documentation. Suggestions to address barriers included patient training for TELE-TOC sessions, amendments to pharmacists’ “visit note”, and better patient preparation for medication reconciliation.

Conclusions:

Using a co-design approach, we integrated multiple perspectives to develop and optimize TELE-TOC—a patient-centered tele-visit intervention-- aimed at supporting discharge care transitions to improve continuity of care and outcomes for patients with COPD. Future research will evaluate the impact of TELE-TOC on readmissions from acute exacerbations.