COVID-19 Virtual Health Programs in a Military Treatment Facility

From the 2021 HVPAA National Conference

Erika Walker (Walter Reed National Military Medical Center), Tameika McLean, Paul Pasquina, Michelle Luken, Adam Bumgardner, Jane Ma, Matthew St. Laurent, Grace Nana Yaa Fordman, Elissa Wolf

Background

COVID-19 challenged the delivery of safe, effective, and high-value healthcare. Acute COVID-19 infection and its sequelae requires a multi-disciplinary approach to identify a comprehensive rehabilitative care plan to address the continuum of symptoms post infection.  Both hospitalized and non-hospitalized patients benefited from telehealth to maximize access to care across a myriad of services.Objective

In April 2020, the Walter Reed National Military Medical Center (WRNMMC) Department of Rehabilitation instituted the Virtual Health Post-Discharge Follow-up Program for all patients discharged with a diagnosis of COVID-19 (POP-1). The goal of this ongoing initiative is to provide an individualized care plan that meets post-discharge needs.  In response to increasing infection levels, in August 2020, the program now termed the COVID Recovery Initiative (CRI) began to capture and contact non-hospitalized service members within the National Capital Region diagnosed with COVID-19 (POP-2) to best understand ongoing needs and offer similar services to POP1.

Methods

Occupational Therapy (OT) focuses on facilitating independence and resumption of activities of daily living utilizing compensation, adaption, strengthening and increasing endurance.  CRI was initiated by the OT team as their interventions in the inpatient setting helped to assess the needs and deficits of patients with COVID-19, particularly physical debility and endurance, respiratory conservation and neuro-cognitive deficits.  The CRI stipulated that OT contact every COVD-19 hospitalized patient within 2-7 days of discharge.  Upon completion of a virtual assessment, OTs initiated individualized treatment plans to ensure comprehensive and holistic care.  Patients are followed 1-3 times per week until the patient demonstrates recovery.  Additional services included Physical Therapy, Pulmonary, Internal Medicine, Nutrition, Behavioral Health, Social Work, and assessments at the National Intrepid Center of Excellence.  A weekly support group is offered to all identified patients with COVID-19. The physicians supporting POP-2 performed a telehealth needs assessment for appropriate follow up; severity and type of symptoms; and patient feedback on COVID-19 care at WRNMMC.  A multi-disciplinary team, led by OT, including Physical Therapy, Internal Medicine, and Social Work meet weekly to discuss all recently discharged patients for further needs assessment and coordination of care.

Results

As of May 2021, approximately 109 patients received virtual health OT initial evaluations and ongoing treatment post-discharge via POP-1.  Despite active-duty patients representing only 20% of overall patient demographics, this group has been followed by OT for the longest period of time post-discharge. COVID-19 patients in this cohort were identified to have ongoing care coordination and/or case management needs, with 37% requiring moderate to extensive case management. POP 1 identifies:

  • gaps in safe, effective care
  • discharge and transition planning
  • physical deficits
  • cognitive and mood changes
  • social isolation and stigma
  • return to work modifications (especially active-duty service members)

POP-2 uncovers prevalent lingering symptoms in non-hospitalized patients.

Conclusions

  1. Hospitalized COVID-19 patients typically require multi-disciplinary ongoing monitoring and follow-up care to address substantial lingering deficits.
  2. Non-hospitalized COVID-19 patients continue to experience a variety of symptoms that may require additional screening and follow-up care.

Clinical Implications

These multi-disciplinary virtual health initiatives continue to improve the quality and safety of care for patient’s diagnosed with COVID-19, regardless of acuity, by combatting stigma and isolation, identifying patients’ needs, connecting patients with services and assisting with returning to valued activities of daily living and work.