The Quality of Telehealth-Delivered Palliative Care During the Initial COVID-19 Pandemic Surge (S530)

OUTCOMES: 1. Describe the use of telehealth-delivered palliative care at one of the largest hospitals in New England during peak COVID-19 infection rates 2. Compare differences in care quality provided by in-person and telehealth-delivered palliative care ORIGINAL RESEARCH BACKGROUND: In March 2020, in response to rapidly increasing COVID-19 infection rates, the palliative care (PC) service at one of the largest hospitals in New England quickly shifted from in-person to telehealth-delivered PC (TPC). RESEARCH OBJECTIVES: We compared the quality of TPC relative to in-person PC during peak COVID-19 rates in the setting of high clinical demands for PC, requiring rapid implementation of TPC. METHODS: We reviewed electronic health records of TPC and in-person consultation modalities of patients hospitalized between 3/2020 and 6/2020. We assessed established quality measures, including time from admission to inpatient PC consultation, interdisciplinary care, documented assessment at initial consultation of patient and family understanding of serious illness, and discussion of goals of care. Descriptive and bivariate statistics were used to describe differences by modality. RESULTS: Among 272 patients, mean age was 69.3 years (standard deviation = 18.3); 53% were male, 65% white, and 24% Black; 33% had primary cancer diagnoses; and 39% had COVID-19. Eighty percent of patients received TPC, and 20% received in-person PC. Median time from admission to PC consultation was 4.5 days (interquartile range 2-11). There were no differences between modalities by race, sex, or time from admission to PC consultation. Patients who received TPC were less likely to have cancer (25% vs 69%; p < 0.01). Patients who received TPC were slightly less likely to encounter more than 1 interdisciplinary PC team member (56% vs 61%) or to have a documented assessment of patient and family understanding of serious illness (60% vs 73%) or discussion of goals of care (71% vs 82%), though not statistically significant (p > 0.05). CONCLUSION: Although PC quality measures varied by modality, the PC service demonstrated the ability to provide high-quality TPC, even under significant strain during the early COVID-19 pandemic. IMPLICATIONS FOR RESEARCH, POLICY, OR PRACTICE: Future work will evaluate opportunities to increase the quality of TPC beyond the initial pandemic surge and for sustained provision of TPC.