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  • January 18, 2022

    By MedStar Team

    Structural racism is one of the most pressing issues facing healthcare today.  Unfortunately, academic medicine historically exacerbating the exploitation of vulnerable communities to achieve educational and research goals, especially in Black, Indigenous, and People of Color (BIPOC) communities. For example, many traditional research practices among marginalized communities highlight and, in most cases, magnify inequities in care. These can include:   

    • Community members are under informed about research methods and strategies. 

    • Researchers prioritize extraction of information from communities rather than community ownership of information.

    • Researchers accrue funding, prestige, and publications (in which academics’ voices predominate over the narrative perspective of community members) without similar accrual to participating communities.  

    • Researchers’ understanding of questions to be answered may lack cultural context because of their incomplete comprehension of community conditions.  

    The relationship between research institutions and many BIPOC communities is estranged and needs mending to dismantle racial disparities and inequitable research practices. As the area’s largest healthcare provider, MedStar Health is committed to do the work needed to address these issues in everything we do in order to advance health equity for everyone we serve.

    “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” – Dr. Martin Luther King, Jr.

    (March 25, 1966 speech to the Medical Committee for Human Rights)

     

    Advancing Health Equity in Early Childhood and Family Mental Health Research

    MedStar Health investigators Arrealia Gavins, Celene E. Domitrovich, Christina Morris, Jessica X. Ouyang, and Matthew G. Biel recently published research emphasizing the need to co-learn and to co-develop research with community members themselves to prioritize benefits for both participants and researchers. “Advancing Antiracism in Community-Based Research Practices in Early Childhood and Family Mental Health” was published in the Journal of the American Academy of Child & Adolescent Psychiatry. This work was done through the Early Childhood Innovation Network (ECIN),  a community-based partnership between two academic medical centers (MedStar Georgetown University Hospital & Children’s National Health System) and several community-based organizations in Washington, DC that strives to provide support to families through caregiver and child mental health services, family peer support, child social and emotional learning, initiatives to address social determinants of physical and mental health for families, and place-based support to families within select communities.  

    In this study, researchers found that to begin to undo the inherent inequities within academic medical research, particularly in studies involving children and caregivers, investigators need to consider how best to build equitable, long-term partnerships with communities through Community-Engaged Research (CEnR) or more specifically, Community-Based Participatory Research (CBPR). CBPR offers an alternative to traditional non-participatory research with a collaborative, strengths-based orientation that equitably involves researchers, community members and other stakeholders in all phases of research while embracing their unique expertise. 

    Recently documented increasing rates of depression, anxiety, and suicide in BIPOC youth, compounded by the disproportionate impact of the COVID-19 pandemic on BIPOC communities, has heightened the urgency for progress in community-based research.

    The research team started to utilize CBPR practices to advance antiracism in their clinical research work in child and family health along with working with BIPOC communities. This approach to integrate CBPR practices into the development, implementation, and evaluation of community-based interventions seeks to support early childhood mental health in primarily Black communities in Washington, DC. 

    Making an Impact: Insights & Lessons Learned from CBPR

    Through this work of the EICN, the research team found five valuable lessons from applying CBRP principles to research collaborations in community settings. 

    Intervention Practices

    Lessons Learned and Applied

    ECIN launched a group-based mindfulness parenting program to explore how to support the emotional health of parents at a Head Start early education center with the intention to reduce caregiver stress and enhance caregiver-child relationships.

     

    Lesson 1: Invest the time to build trusting relationships

    Providers set up several discussion groups with community partners and medical center-based researchers to review proposed assessment tools to be used with children and families receiving psychotherapy services.

    Lesson 2: Involve community partners in the development of the intervention theory of change and measurement strategy

     

    Clinical staff organized peer specialists to provide support to families with young children through 3 evidence-based strategies: enhancing parents’ knowledge about caregiving with young children;optimizingparent use of existing resources; and increasing parents’ access to social supports.

     

    Lesson 3: Create interventions in partnership with community members

    Clinical staff providedearly childhood mental health consultation (ECMHC) in preschool classrooms to enhance educators’capacitiesto support early childhood development and to recognize early signs of mental health concerns

    Lesson 4: Interpret findings in partnership with community members

    ECIN membersparticipatedin formal antiracism training with external experts to incorporate antiracism principles into ECIN’s operations and into the culture of the Network. ECIN formed a Racial Equity Community of Practice (RECOP), that supports 8 intervention teams in developing practices that advance racial equity goals.

    Lesson 5: Embed an antiracism focus in research structures and processes

     

    The research team found this community-based approach to be helpful in conducting research that will have a long-lasting impact on not only the community, but also on members of the research team. During a time where BIPOC families are experiencing the effect of COVID-related deaths and grief, unemployment, housing instability, and police violence; researchers have an opportunity to be engaged in the community and work to eliminate racial inequities within academic medicine and research. 

    Journal of the American Academy of Child & Adolescent Psychiatry, DOI: 10.1016/j.jaac.2021.06.018

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  • September 10, 2020

    By James E. Tozzi, MD

    As patients age and their concerns about maintaining a better quality of life grow, joint reconstruction surgery becomes a reality for more and more of them. Nationally, there are over a million joint replacement procedures every year, with the large majority being hip and knee replacement surgeries.

    At MedStar Washington Hospital Center, we perform more than 1,000 joint replacement surgeries annually at our state-of-the-art orthopedic facility. Our comprehensive program begins with Joint Class, a sort of dress rehearsal to help prepare patients for what they will experience in their procedure, from beginning to end.

    The expertise of our fellowship-trained surgeons, combined with the strengths and resources that come with being part of a major medical center, help us achieve a patient satisfaction level of over 95% for our total knee and total hip replacement surgeries.

    If you think there may be a knee or hip replacement in your future, we can provide you with the comprehensive background to help you make an informed decision about your treatment. Here are some questions we frequently get asked:

    • When should someone start to consider surgery?
      This is a complex question, as every patient is different. Usually, the affected party is experiencing chronic pain that is interfering with performing basic activities of daily living… and they’re noticing their pain medications no longer offer relief.The majority of people in this situation are 50 to 80 years old and suffer from age-related degenerative arthritis in the joint. Eighty percent of people who have total hip or total knee replacement have osteoarthritis; another 10–15% suffer from inflammatory diseases like rheumatoid arthritis. And occasionally we see a patient who’s had a traumatic injury to the joint, as in the case of professional football and baseball player Bo Jackson.
    • What factors lead to choosing surgery?
      The conversation around choosing surgery may begin when you tell your primary care doctor that “My knees (or my hips) are really hurting again… and I’m just not getting any better with the medicine you prescribed.” Your doctor will likely tell you it’s time to see an orthopedic specialist, and that’s when I’ll see you. Many patients also skip the primary care path and come directly to us with their serious joint pain.The orthopedic surgeon will give your affected joint or joints a thorough examination and take x-rays to view the level and type of damage present there. He or she can also help you understand options to better manage your pain via non-surgical approaches, such as reducing your weight, exercising properly, medication, or even injections to help reduce inflammation that causes pain.And of course, the orthopedic surgeon can help you assess if and when it’s time to consider surgical options and discuss which of those may be right for you. In the end, the decision is always yours.
    • How do I prepare for joint replacement surgery?
      Your surgeon will work with you, your doctor, and other specialists to ensure you’re medically ready for your procedure. This can include helping you with weight reduction, getting your blood sugar in line if you’re diabetic, and making sure no medical conditions are present that might complicate surgery for you.Before your surgery, we’ll enroll you in Joint Class, where you’ll use the time before your surgery to prepare, not just for the procedure but also for the post-operative rehab. You’ll learn what to expect and get practical experience with the exercises you’ll need to do afterwards. Besides the physical benefits, we find that Joint Class can help you feel less anxious going into surgery. So, you’re better prepared when you leave the hospital—and more likely to have a faster recovery.
    Most knee or hip joint replacement patients will leave the hospital in 1–3 days. And when they leave, they leave walking, says orthopedic surgeon Dr. James E. Tozzi. Learn more. https://bit.ly/31HtFoZ via @MedStarWHC
    Click to Tweet

    • What can I expect from my surgery… and from recovery?
      Typically, from beginning to end, the average total knee or total hip replacement surgery requires about two hours—perhaps a little less, depending upon the patient. At MedStar Washington Hospital Center, your surgeon is supported by a highly proficient surgical team, and the full resources of a major medical center in the rare instance where a complication might arise.Most recovering patients will leave the hospital in a range of one to three days. Day One following surgery, there’s usually physical therapy, sometimes even while you’re in the recovery room. And when you leave, you leave walking. So you return home already mobile, maybe even able to climb stairs. We control any pain with medication, which you may take for anywhere from a few days to up to three months.Depending on your unique scenario, we look for you to return to full activity at about six weeks. Of course, that can depend on what “full activity” means for you. You probably won’t be back on the golf course for about three months. But swimming is okay once the incision is fully healed. Walking is immediate—it’s just a matter of building up endurance.

    So What Can Joint Replacement Candidates Expect From MedStar Washington Hospital Center?

    When you come to see us, you’ll first be thoroughly evaluated. It’s critically important that we work together to ensure you have the most successful outcome from your joint surgery. This includes preparing a checklist of things that your primary care physician will help you complete to get you medically ready for your procedure.

    We also give you access to the physical therapists, social workers, and Advanced Practice Providers who work with us, and their input is also addressed as part of the process. Then, you will attend Joint Class to get you fully prepped and looking forward to your successful surgery. In addition, our Joint Coordinator will ensure that, when your prep is complete, you have a surgery date scheduled.

    Before, during, and after your surgery, we are caring and involved in a multidisciplinary way to effectively help worn-out or damaged joints. Our goal is always to give you the best outcome you can possibly expect and help you restore normal, healthy mobility to your life.


    Considering joint replacement surgery?

    Our specialists can help.

    Call 202-644-9526 or  Request an Appointment

  • September 09, 2020

    By The MWHC Blog Team

    “A career in medicine was always in the back of my mind,” Tani Jausurawong Wiest, DO, says of her childhood in Northern Virginia’s suburbs. It wasn’t until her undergraduate years at Virginia Tech that those ambitions came into sharper focus. Dr. Jausurawong Wiest recalls how her sorority’s philanthropy activities frequently exposed her to underserved rural communities not far from campus.

    “It was sad to see how many people didn’t have easy access to health care,” she says. “That really motivated me to do my part to help.”

    After graduating from the Edward Via College of Osteopathic Medicine, Dr. Jausurawong Wiest completed a combined residency in internal and emergency medicine at Jefferson Health—Northeast in Philadelphia. She returned “home” in 2017 for a critical care fellowship through the MedStar Georgetown University Hospital/MedStar Washington Hospital Center program, and welcomed the opportunity to join the Hospital Center’s Critical Care staff last year as an attending physician.

    Why Critical Care Medicine?

    “Critical care found me,” Dr. Jausurawong Wiest says of her specialty. “I discovered how I could make a big impact in patients’ lives and help their families as well. I was also fortunate to work with some great intensivists who helped shape my career direction and interests.”

    As a Doctor of Osteopathic Medicine, Dr. Jausurawong Wiest always tries to approach patient care in a holistic manner while also focusing on symptoms.

    “We are taught to consider the whole patient—mind, body, and spirit—and use these principles to advance care out of the ICU, keeping in mind that each patient’s needs may differ,” she explains. In addition to her clinical work, Dr. Jausurawong Wiest coordinates the Hospital Center’s Surgical Critical Care fellowship program.

    “Having recently completed the program myself and transitioned into professional practice, I know the training fellows need as they reach this stage,” she says. “I’m honored to have the opportunity to help shape the program.”

    Outside of Work

    Medicine has also found its way into Dr. Jausurawong Wiest’s home life, as her husband, Philip, is a federal patent examiner specializing in biomedical devices. In addition to her longtime interests in travel, working out, hiking, and trying new restaurants, Dr. Jausurawong Wiest recently joined a social book club to help get into the habit of reading for pleasure.

    “It’s not quite as rigorous as medical school,” she says with a laugh, “but they are very serious about participating and keeping up.”


  • September 08, 2020

    By Min Deng, MD

    It can certainly be frightening to hear the diagnosis: that innocent-looking spot on your face is a skin cancer. And it’s going to require surgery.

    But Mohs micrographic surgery can provide peace of mind. This advanced microscopically guided procedure offers a precise, layer-by-layer removal of the cancer that achieves up to a 99% cure rate while sparing normal healthy skin.

    During Mohs surgery, a surgeon removes the patient’s cancerous skin lesion and color-codes the margins of the tissue to indicate its exact origin in the skin. The entire sample is then frozen and stained, and the complete surgical margins are analyzed in real-time in the Mohs lab. If cancerous cells remain in any section of the tissue, the surgeon returns to the operating room to remove the cancer from its precise location. The process is repeated until all cancerous cells are removed, allowing the surgeon to map the exact margins of the cancer and excise the entire tumor.

    What Are the Benefits of Mohs Surgery?

    The primary benefit of Mohs surgery is precision. In traditional surgery for skin cancer removal, the surgeon must estimate how deep and wide the cancer extends, which can result in unnecessary removal of healthy tissue or incomplete removal of cancer cells. By contrast, Mohs surgery allows the surgeon to see the margins of the skin microscopically during the procedure, so all cancerous cells are removed, while ensuring as much healthy tissue as possible is preserved.

    It can be a frightening diagnosis: that innocent-looking spot on your face is a skin cancer. But #MohsSurgery can offer peace of mind, says Dr. Min Deng. #SkinCancerRemoval https://bit.ly/3m4yH6K via @MedStarWHC
    Click to Tweet

    This precision makes Mohs surgery an incredibly effective treatment for skin cancer; the procedure has a cure rate of up to 99%. Because this method preserves the maximum amount of healthy tissue, it also results in minimal scarring.

    When Is Mohs Surgery Used?

    Mohs surgery has traditionally been used to treat basal and squamous cell carcinomas. It is commonly used to remove skin cancer from functionally and cosmetically sensitive body sites, such as the head and neck, hands and fingers, and genitals.

    It can also be used in more advanced or complex cases, including tumors that have recurred and large tumors that are greater than 2 cm in diameter. Skin cancer on the nose, eyelids, lips, ears, hands, feet, and genitals are considered particularly high-risk.

    In recent years, Mohs surgeons have even adapted this method to treat more complex types of skin cancer, such as melanoma and other skin cancer types.

    Recovering From Mohs Surgery

    Most patients recover very well from Mohs surgery. For the first 24 hours after surgery, patients may experience mild pain or discomfort around the surgical site, which is easily managed with acetaminophen.

    To minimize the risk of bleeding, I always advise my patients to take it easy for the first two days after surgery. Patients with sutures may need to avoid lifting heavy objects or participating in strenuous activity until the sutures are removed (usually within one to two weeks). Depending on how deep the tumor extends, some patients may notice numbness in the affected area, but this usually fades as the nerves regenerate. Since this is a surgical procedure, there will be a scar, however Mohs surgeons are trained to hide these scars and help them blend into the surrounding skin. Within about one year, most people will notice their scar has faded.

    Most patients do not require further treatment after undergoing Mohs surgery. However, if you have undergone the procedure, it is important to continue following up with your regular dermatologist. Approximately 60% of people who have had one skin cancer will be diagnosed with a second within 10 years, so continued vigilance is vital.

    Choosing a Mohs Surgeon

    Mohs surgery is an excellent treatment option for many types of skin cancer, including skin cancers of the head and neck, hands and feet, and genitals, as well as more complex and advanced cancers.

    Whether the case is simple or complex, a fellowship-trained Mohs surgeon can provide treatment that is effective both clinically and cosmetically.

    At MedStar Washington Hospital Center, we are proud to offer cutting-edge Mohs surgery. A qualified member of our team can help you decide if it’s the right treatment for you.

    LISTEN: Dr. Deng discusses Mohs surgery in the Medical Intel podcast.


    Ready to explore Mohs surgery?

    Connect with our dermatology team.

    Request an Appointment or call 202-644-9526

  • September 07, 2020

    By Dr. Loral Patchen, PhD, MSN, MA, CNM Certified Nurse Midwife, Vice Chair, Innovation and Community Programs, and Section Director for Midwifery at MedStar Washington Hospital Center

    Many times, it’s hard to pinpoint the cause of preterm birth, or birth before 37 weeks of pregnancy. And once you’ve delivered a preterm baby, you’re at an increased risk of having another preterm birth. While preterm birth isn’t always preventable, there are steps you can take to reduce your risk of having another baby prematurely.

    What are the risks of preterm birth?

    While medical advances have increased the likelihood that babies born prematurely can survive, babies born too early may experience short-term and long-term health problems that vary based on how early they were born. Babies born extremely preterm—less than 25 weeks—will face more health challenges than those born closer to 37 weeks. There is also an increased rate in infant mortality. Preterm birth complications can range from vision and hearing, to delayed cognitive and social development that can last a lifetime.

    Who is at risk of preterm birth?

    There are certain risk factors that increase your chances of delivering a baby early. For example, being pregnant with multiples, having babies close together, or experiencing health-related complications during pregnancy, like gestational diabetes. Yet, many women with preterm birth risk factors go on to deliver healthy, full-term babies which is why it’s challenging to predict—or prevent—a preterm birth.

    In addition, Black women are at an increased risk of experiencing preterm birth. In fact, the Centers for Disease Control and Prevention (CDC) suggests that the preterm birth rate among Black women was about 50% higher than the preterm birth rate among non-Hispanic white women in 2018. The data presents an opportunity for the U.S. health system to understand and change what’s happening systematically that affects things like bias and support for all women, irrespective of ethnicity, education, or wealth.

    While #PretermBirth isn’t always preventable, #Midwife Dr. Loral Patchen shares six things you can to do reduce your risk of delivering a baby early on the #LiveWellHealthy blog: https://bit.ly/30KrFeF.

    Click to Tweet

     

    Tips for reducing your risk of preterm birth.

    While preterm birth is hard to prevent, there are a few things you can do to lower your risk of delivering a baby early.

    1. Establish a strong support system.

    Studies suggest that having a strong support system can help to prevent preterm birth because surrounding yourself with people who can help you can lower your risk of stress or depression. A supportive network looks different for everyone but consider asking yourself the following questions to help determine what will make you feel safe and prepared for your baby:

    • What do I need to feel safe in this pregnancy?
    • Who can help me to make good lifestyle choices and decisions related to pregnancy?
    • What techniques can I use to reduce my stress? (e.g. meditation, mindfulness, walking, etc.)
    • How can I find access to a therapist or professional if I’m feeling anxious or depressed?

    2. Have an easy and fast way to get in touch with your care team.

    Whether it’s your first pregnancy or third, be sure you have an easy and quick way to get in touch with your care team directly. It ensures that someone can advise you on what to do if you’re concerned about preterm contractions or other warning signs, like cramping or bleeding. You don’t have to figure it out on your own. Having a care provider just a phone call away can get you the help you need when you need it.

    3. Plan your pregnancies at least 18 months apart.

    Women who get pregnant with a second baby within six months of their first are at an increased risk for delivering a baby prematurely. So, one way to reduce your risk of preterm birth is to try spacing out your pregnancies at least 18 months apart. Using an effective contraceptive and waiting to get pregnant following your first baby gives your body time to recover after pregnancy. Talk to your doctor about what contraceptive or family planning methods may work best for you.

    4. Maintain a healthy weight.

    While most instances of preterm birth can’t be attributed to a specific cause, certain chronic health conditions, like obesity, diabetes, and high blood pressure, can increase your risk of having a baby too early. To lower your chances of delivering a baby preterm, talk to your doctor about how to achieve a healthy body mass index through exercise and a nutritious diet—both of which will be important for maintaining your health during pregnancy.

    5. Avoid smoking and substance use.

    Smoking and recreational drug use can increase your risk of preterm birth. So even if you’ve tried unsuccessfully to quit before, now is a great time to try again. Talk to your healthcare provider about how they can help support you stop smoking or using recreational drugs.

    6. Protect yourself against infections.

    An infection in the uterus is a medical reason for delivering a baby preterm and often the most obvious cause for early birth. Any kind of infection can compromise your immune system, increasing your risk of health problems. And, certain infections, such as a sexually transmitted infection (STI), can directly affect your baby in the uterus. That’s why it’s important to get tested for STIs early in pregnancy to rule out any chances of an infection.

    Safe Babies Safe Moms initiative.

    One way MedStar Health is addressing the needs of expecting moms and babies is through the D.C. Safe Babies Safe Moms initiative, made possible by the A. James & Alice B. Clark Foundation. The program brings together nationally recognized experts in women’s health, family medicine, behavioral health, and pediatrics at both MedStar Washington Hospital Center and MedStar Georgetown University Hospital to lower infant mortality rates among pregnant women in Washington D.C. The initiative offers a holistic and multi-generational approach to improving outcomes for mothers and children in the nation’s capital by offering services that aren’t traditionally offered by health systems. These services address social determinants that impact health, from food insecurity and transportation to mental health support and emotional stability.

    A preterm delivery may not always be preventable. But, having a supportive care team can help you navigate pregnancy and motherhood with the resources you need to feel secure, safe, and prepared.

    MedStar Health is looking forward to bringing the Safe Babies Safe Moms initiative to D.C. 
    Click below to learn more about the program.

    Learn More

  • September 05, 2020

    By MedStar Team

    Throughout the COVID-19 pandemic, criminals have used the crisis as a basis for increased attacks on computer systems, including phishing campaigns. These attacks are organized and often specifically target healthcare systems or individuals to collect sensitive business or personal information.  

    Phishing is a constant threat, but there is also a seasonality to cyberattacks, with more coming during traditional vacation times, when criminals assume defenses are lowered and staffing may vary due to time off. As organizations, including MedStar Health, navigate a new normal, experts anticipate new email phishing attacks attempting to exploit changes, such as adjustments to revised workflows and remote working arrangements.

    Associate vigilance is among our best defense strategies for savvy attackers who prompt associates to provide personal information or passwords, click on or open malicious links or attachments, or transfer money. Attacks can come through phishing emails, texts or voice calls to a workstation, smartphone or other device.

    Malicious senders may spoof a known source for COVID-19 information, such as the Centers for Disease Control and Prevention (CDC), MedStar Human Resources, or a local school district or government office. Phishing attempts may also come from from vendors purporting to have or sell Personal Protective Equipment (PPE). 

    To avoid these risks, always follow these important recommendations: 

    • Take your time when reviewing email or text messages. Use caution before you click!
    • Be alert for phishing messages in your email inbox. Since phishing emails arrive from outside of the network, determine whether the email is legitimate. All external emails include a tag of [EXTERNAL] in the email subject line and a banner:

    ** ATTENTION: This email originated from outside the MedStar network.
    ** DO NOT CLICK links or attachments unless you recognize the sender and know the content is safe.

    • If you don’t know the sender and it looks suspicious, delete the email. Do not click on any attachments or links within the body of the email.
    • Look for spoofed addresses. For example, if an email appears to come from an associate and the sender’s address is not @medstar.net, it is not a legitmate email.
    • If you receive a text message from a number you do not know, delete the text message. Do not click on any links within the text message.
    • Report suspicious emails to phish@medstar.net. Call the IS Service Desk at 877-777-8787 with any questions.

    Thank you for your efforts to protect our network, data, systems, and organization.

  • September 05, 2020

    By MedStar Team

    A collaborative team of researchers from across MedStar Health recently published research evaluating the performance of on-demand telehealth as an approach to respond to COVID-19. The team included investigators from MedStar Health National Center for Human Factors in Healthcare, MedStar Telehealth Innovation Center and the MedStar Institute for Innovation.

    “A Descriptive Analysis of an On-Demand Telehealth Approach for Remote COVID-19 Patient Screening” was published in Journal of Telemedicine and Telecare. The analysis presented by the investigators covers telehealth patient characteristics, measures of patient wait time and visit duration, technical success of the telehealth request and the post-visit trajectory of these patients.

    The study evaluated 9,270 on-demand telehealth requests from 7,112 unique patients from March to April 2020.  Each telehealth request was categorized as either a completed encounter in which the patient successfully saw the provider and was given clinical guidance, or an incomplete request in which the patient did not complete an encounter with the provider. For completed encounters, additional analyses were performed, and the patient was provided a survey and asked what they would have done if on-demand telehealth was unavailable.

    The results show that out of the over 7,000 unique patients with on-demand telehealth requests, the average patient age was around 38 years old, 4,511 were female and 2,601 were male. Most requests (61.6%) had a visit reason categorized as likely COVID-19 related. The majority (79%) of likely COVID-19 related requests were completed encounters and of these, 19% were referred for in-person care or testing. The average completed encounter wait time was 26 minutes. In addition, there were 1194 requests that were categorized as left without being seen. The average wait time for patients that left without being seen was 19 minutes.

    The post-encounter survey, for patients who had a completed visit, indicated that 26% of patients would have gone to an urgent care or retail clinic if on-demand telehealth was unavailable. There were 482 patients (10.7%) who said they would go to their doctor’s office and 267 (5.9%) would go to the ER. The survey showed 9.1% of patients would not have done anything.  There was no response from 48% of completed encounters.

    The research concluded that on-demand telehealth service can serve an important public health need in response to the COVID-19 pandemic. According to the survey, 1935 (42.8% of the 4518 COVID-19 related requests) patients would have sought in-person care had they not had access to on-demand telehealth.  There were several patients who stated they would have done nothing about their concerns. On-demand telehealth helps to decrease personal exposure and demonstrates a low-barrier approach to screening patients for COVID-19.

    The research team included MedStar Health’s Raj Ratwani, PhD; David Brennan; Bill Sheahan; Allan Fong; Katharine Adams; Allyson Gordon; Mary Calabrese; Elizabeth Hwang; Mark Smith, MD; and Ethan Booker, MD.

    Journal of Telemedicine and Telecare, 2020. DOI: 10.1177/1357633X20943339