Shifting healthcare delivery modes during a COVID-19 outbreak in the United States

Several major impacts can be anticipated during a severe outbreak that could affect the operations of healthcare facilities. These include surges in patients seeking care, the potential for workforce absenteeism for personal or family illness, and effects from community mitigation approaches such as school closures. Healthcare facilities will likely need to adjust the way they triage, assess, and care for patients by using methods that do not rely on face-to-face care.

Facilities can reduce exposure of HCP to ill persons and minimize surge on facilities by shifting practices to triaging and assessing ill patients (including those affected by COVID-19 and patients with other conditions) remotely using nurse advice lines, provider “visits” by telephone, text monitoring systems, video conferences, or other telehealth and telemedicine methods. Many clinics and medical offices already use these methods to triage and manage patients after hours and as part of usual practices. Recent reports suggest that approximately 80% of COVID-19 patients (of all ages) have experienced mild illness (Wu et al 2020external icon).  Managing persons at home who are ill with mild disease can reduce the strain on healthcare systems, however, these patients will need careful triage and monitoring.

Promoting the increased use of telehealth

  • Healthcare facilities can increase the use of telephone management and other remote methods of triaging, assessing, and caring for all patients to decrease the volume of persons seeking care in facilities.
  • If a formal telehealth system is not available, healthcare providers can still communicate with patients by telephone instead of in person visits which will reduce the number of those who seek face-to-face care.
  • Health plans, healthcare systems, and insurers/payors should communicate with beneficiaries to promote the availability of covered telehealth, telemedicine, or nurse advice line services.

Shifts in the way that healthcare is delivered during a COVID-19 outbreak response will be complex. Thorough and consistent communications between all components of the public health and healthcare system will be needed in every community. Providers in medical offices, clinics, and other outpatient settings should be informed and know their roles as they evolve. Pre-hospital care by emergency management services (EMS) and public-safety answering points (PSAPs) will also need to be coordinated and consistent with current transport guidance so they can conduct in-home assessments and triage per local guidance.

Additional telehealth information by region and state can be found at the National Consortium of Telehealth Resource Centersexternal icon and the Center for Connected Health Policyexternal icon).

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