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An Evaluation of Virtual Care for Gestational Diabetes Using the Quadruple Aim Framework: Assessment of Patient and Provider Experience, Cost and Clinical Outcomes

Published:December 16, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.12.002

      Abstract

      Objective

      Our aim in this study was to evaluate the impact of virtual care for gestational diabetes mellitus (GDM) in the context of the COVID-19 pandemic.

      Methods

      This multiple methods program evaluation used the Quadruple Aim Framework. The impact on patient experience, cost and provider satisfaction was assessed using surveys and interviews. Chi-square and Poisson statistics were used to compare clinical outcomes before (April 2019 to February 2020) and after (May 2020 to March 2021) the shift to virtual care.

      Results

      Patient experience surveys were completed by 85 women. Most of them rated their virtual care experience as good or excellent (93%), with a preference for continued virtual visits in the future (84%). Most respondents felt virtual care saved them money (93%) and time (98%). Six health-care providers at the Diabetes in Pregnancy Clinic were interviewed and all believed the switch to virtual care was largely positive. Overall, interview transcripts revealed that health-care providers were happy with the transition, although nurses initially perceived an increased workload. There were no significant differences in rates of cesarean section procedures, macrosomia, neonatal intensive care unit admissions or the proportion of appointments at which insulin was initiated between in-person and virtual care patient outcomes. There was a decreased proportion of missed appointments after the switch to virtual care (6.15% vs 1.21%, p<0.0001).

      Conclusions

      There has been high patient and provider satisfaction with virtual GDM care, with no difference in clinical outcomes and fewer missed appointments. Virtual GDM care should remain an option in the future.

      Résumé

      Objectifs

      Évaluer les répercussions des soins virtuels offerts aux femmes atteintes de diabète gestationnel (DSG) dans le contexte de la pandémie de la COVID-19.

      Méthodes

      La présente évaluation du programme par méthodes mixtes reposait sur le cadre aux objectifs quadruples (Quadruple Aim Framework). Les enquêtes et les entretiens ont permis d’évaluer les répercussions de l’expérience des patientes, les coûts et la satisfaction des prestataires de soins. Le test statistique du khi-carré et la loi statistique de Poisson ont été utilisés pour comparer les résultats cliniques avant (avril 2019-février 2020) et après (mai 2020-mars 2021) la transition vers les soins virtuels.

      Résultats

      Quatre-vingt-cinq femmes ont rempli les enquêtes sur l’expérience des patients. La plupart considéraient que leur expérience des soins virtuels était bonne ou excellente (93 %) et préféraient que dorénavant les rendez-vous se poursuivent virtuellement (84 %). La plupart des répondantes estimaient que les soins virtuels les faisaient économiser de l’argent (93 %) et leur temps (98 %). Les 6 prestataires de soins de la clinique de diabète gestationnel interrogés trouvaient la transition vers les soins virtuels très positive. Les transcriptions des entretiens révélaient que dans l’ensemble les prestataires de soins étaient satisfaits de cette transition, bien que les infirmières aient initialement perçu une augmentation de la charge de travail. Aucune différence significative n’était observée dans les taux de césariennes, de macrosomie, d’admissions à l’unité des soins intensifs néonatals (USIN) ou la proportion de rendez-vous lors desquels l’insuline était amorcée entre les cohortes des soins virtuels et en personne. Une proportion moindre de rendez-vous étaient manqués après la transition vers les soins virtuels (6,15 % vs 1,21 %, valeur p < 0,0001).

      Conclusions

      La satisfaction des patientes et des prestataires à l’égard des soins virtuels était élevée, les résultats cliniques ne montraient aucune différence et moins de rendez-vous étaient manqués. Les soins virtuels offerts aux femmes atteintes de DSG devraient dorénavant demeurer une option.

      Keywords

      Mots clés

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