Occupational Therapy Home Visiting service via virtual care

Our approach is pragmatic and aims to integrate and measure the impact of virtual care in home visiting. We are yet to identify if virtual care delivers the same clinical outcomes for patients and the health system in the area of home visiting. For example, do patients receiving virtual care require the same number of intervention sessions to achieve the same clinical outcomes? We will determine: • “when,” “how,” and “how much” care should be delivered virtually • Differentiate between care journeys (based on patient diagnosis, referral reason, etc.) • Design a holistic care model in which virtual and face-to-face care complement one another. • Fine-tune the virtual experience to meet consumer expectations and drive satisfaction. • Understand the cost implications for service provision and future resource implications. This study aims to determine whether delivery of an occupational therapy home visiting service using a virtual care model reduces therapy time while being non-inferior to a traditional face-to-face model of care in regard to adverse events and is supported by patient satisfaction. A non-inferiority model will be utilised as we are interested in whether the new treatment (virtual care) is “not worse” than the existing treatment (face-to-face home visit delivery). To reduce risk to patients and staff during the global pandemic, virtual care use was introduced into standard practice in early 2022. A hybrid model of virtual care includes a mixture of virtual care and face-to-face services, which is likely to be sustainable in future clinical practice. The majority of services are provided virtually (i.e. initial, cognitive and functional assessments, equipment education and set up, patient and carer education), with face-to-face utilised only if necessary (i.e. due to a patient’s inability to use virtual care, lack of patient ability or family support to set up equipment, clinical need, etc.). Therapists utilise Health Direct Video Call videoconferencing platform. There is no formal training required with resources available on the hospital intranet website as required. All patients receive an initial risk screening introductory telephone call which will be completed within 5 days of referral and last approximately 30 minutes. This is followed by further appointments consisting of virtual care assessment (i.e. initial, functional or cognitive assessments) and intervention (i.e. patient and carer education, equipment setup) either via telephone or video (dependent on factors such as a patient’s needs, equipment availability, family support, patient’s preference, etc.) lasting approximately 60 minutes. Frequency of follow-up appointments will be determined on a case-by-case basis. If care is required post the 4-6 week follow up period it will be provided but not included in the results. Two researchers will purposively case match participants by age and diagnosis from the occupational therapy department clinical database for patients that have received virtual care compared to a face-to-face home visiting service. Data extracted from the clinical database will include: date of referral, source of referral, type of assessment and intervention provided, mode of service delivery and reasons for escalation to a face-to-face home visit (if a case patient). The database also provides information on any encountered issues with virtual care such as technical or safety issues. The Functional Independence Measure, Clinical Frailty Scale and Charlson Comorbidity Index will be used to describe patient function. Other covariates, such as sociodemographic data, diagnosis, comorbidities and referral reason will be obtained from medical records. A subset of patients will be approached on the telephone or by mail post receiving a virtual care home visiting service to survey their satisfaction (Telehealth Usability Questionnaire). Purposive sampling strategy will be employed to recruit participants as researchers will select those participants who have received a virtual care home visit within two months to ensure patient recall.