Telehealth Primary Care Management Program in the African American Community: A Quality Improvement Project

Project Description and Purpose

According to Stephen et al., (2019), advancements in technology have contributed to improvements in delivering healthcare services and information. Incorporation of technology in healthcare systems has helped in easing the access of services, improved patient outcomes, and reduction of congestion in healthcare facilities. Technology has helped in the invention and development of more effective strategies for delivering care. Notably, there has been progressive research on ways of improving the quality of care by applying technology in healthcare systems (Tuckson et al., (2017). Development of better management programs by incorporating technology in the healthcare system has helped to revolutionize care delivery globally. As defined by Stephen et al., (2019), telehealth is the application of telecommunication and electronic means in delivering healthcare services or information. With the high prevalence of illnesses among the African American community, there is a need to research ways that can help improve the quality of care and patient outcomes by use of technology.

With the target population in this research being in the inner cities, the patient-to-physician ratio is inefficient, therefore, researching on better management programs by application of technology in delivering care is important.

Healthcare statistics in the United States show that there is inequality in healthcare access and patient convenience among different ethnicities. According to Cuevas et al., (2016), the African American community is among the most affected community.  The purpose of the proposed project will be to research how the application of technology in primary care programs among the African American community has affected the access the healthcare. The proposed project will also research how telehealth has led to quality improvement of care in primary settings among the target population. The project will compare the target community’s experiences before the incorporation of telehealth and after its incorporation. In this project, the problem to be addressed will be how telehealth in primary care management has improved the quality of healthcare among the African American community.

Expected Outcomes

The identified research need will be solved by the utilization of effective strategies in the proposed project. It is expected that the study will explore the healthcare quality in the African American community and the changes noted after the incorporation of telehealth in the primary care management programs. Using the data that will be collected as defined in this project proposal, the study will assess how convenience, ease of access to healthcare services and information and quality of care among the target population have been improved through the introduction and incorporation of telehealth in primary care programs. It is expected that challenges faced in applying telehealth systems in care provision and implementation of management programs will be identified. The study is also expected to help in the identification of available opportunities in the incorporation of telehealth interventions such as patient-reminder calls in the African American population.

Healthcare providers, developers and suppliers of telehealth systems, African Americans and fellow researchers are major parties expected to benefit from the conduction of this project. To the developers and suppliers of telehealth systems, the project will help in providing essential findings on ways they can improve the user experience of the systems through the advancement of the current systems. The study is expected to explore future opportunities in telehealth application and provide the developers with ideas on ways of enhancing the systems’ sustainability. The project is expected to benefit the healthcare provider in the journey of ensuring the improvement of quality and healthcare service access.  The healthcare providers are also expected to benefit from this project in their quest of improving the patient convenience by incorporating telehealth in the healthcare system in the target population. Through the implementation of the project’s recommendations by healthcare providers and developers, the target population is expected to have improved access to healthcare services and information, improved quality of the primary care services and the reduced cost incurred when seeking healthcare. On the other hand, the study is expected to benefit future researchers who will carry out studies concerning the same research problem as the project will provide relevant and significant considerations.  The project findings are expected to initiate interests in research to evaluate the impact of telehealth incorporation in other subpopulations in the United States.

Background and Significance

As a result of the application of telecommunication and electronic technology in the healthcare systems, there have been significant changes in delivering health-related information and services. According to the American Hospital Association (AHA), healthcare facilities implementing telehealth in 2017 increased from 35% to 75%. However, there were low rates of telehealth adoption in the African American community. Increase in the adoption of telehealth has helped improve the quality of care, reduced medical cost, improved patient outcomes and reduced illness prevalence in primary care. Lee et al., (2019) states that the current healthcare system can be changed through improved telehealth hence improving the patient outcomes and access to healthcare in cost-effective ways. The project is significant as it will provide strategies that can be used to improve telehealth adoption rates in the target population.  It is essential to carry out more studies to ensure improved efficiency and patient outcomes through the incorporation of telehealth.  The proposed project will help in establishing a culture of improved quality of healthcare. The project will help in the determination and identification of potential areas of the target community that require improvement. The project will positively impact the healthcare system by providing a better understanding and identification of means of improving telehealth. With this project, the identification of healthcare barriers will be easily identified to ensure improved adoption of telehealth in the target community. Increased collaboration between physicians and patients will be witnessed as a result of this project hence increased adoption of telehealth management programs in primary care. The healthcare system, particularly in the target population, will have increased adoption rates of technology in the delivery of healthcare services and information. The project will ensure the patient population in the inner cities and rural areas will have improved access to health-related services and information. It is a study that will also help in identifying to means applicable in the standardization of the physician-to-patient ratio hence reducing overcrowding in healthcare facilities. Research according to Goldstein et al., (2018), 74% of the patients in the US have no problem with using technology in the process of care delivery.

It is a quality improvement project, there will be an improved quality of healthcare in the target population. It will also lead to a higher performance in the healthcare systems hence achieving the patient outcomes. With this project, care providers will have better working environments that will help in the improvement of the patient and health outcomes. Healthcare systems in the African American community will ensure to implement systematic approaches in achieving the optimization of telehealth. The project will help to improve telehealth by increasing its safety, quality and transparency. Improvement of telehealth in primary care among the African American population reducing the probability of failure and redundancy in the healthcare system. The project will ensure that care provided is patient-centred as clinical and managerial processes will be more efficient ensuring that care is value-based, responsive and respectful. As a result of this project, issues in telehealth will be easily recognized and solved before they occur. With the proposed project being budget neutral, failures related to an error, costs and poor outcomes witnessed in the incorporation of telehealth in the African American community will be avoided. Less expensive and reliable processes of improving telehealth will be identified after the conduction of this project. The proposed project will help in improving ways of delivering health-related information and services to patients in the target population. With the study aiming at improving telehealth quality among the Africa Americans, the study will help in developing management programs and procedures that will ensure the improvement of healthcare quality and patient outcomes. With this project, healthcare providers will come up with ways of increasing telehealth awareness and education among the target population and ensure an environment that ensures the quality of care to be a priority. Management programs that will help in developing a progressive urge to upgrade the healthcare system through telehealth will be recommended in this project. With the proposed project, the healthcare sector will be pulled out from traditional and inefficient management programs and adopt modern concepts of care delivery through telecommunication and electronic technology hence improved quality of care.

Relationship of Project to DNP Essentials

The proposed project will provide comprehensive insights necessary for the practice in incorporating technology in delivering health-related services and information. The project will help in developing effective leadership and organizational strategies that can be used in improving the use of technology in healthcare delivery among the African American community. During data collection, the proposed project will ensure to use evidence-based resources and will follow procedures that will ensure the promotion of evidence-based practice.  The project relates to the DNP essentials as it seeks to find means of improving patient care by use of technology. The project will positively impact the nursing science as care providers will have an opportunity to contribute to an effective translation, evaluation and study dissemination in the practice.

The proposed project will involve the application of technology in the improvement and transformation of healthcare hence closely relating to the DNP essentials. Different stakeholders will collaborate in this project having an interactive research process with the objective of improving patient outcomes in the target community. With the project aiming at improving healthcare among the African American community, the recommendations provided will translate to an overall improvement of the nation’s healthcare sector hence relating to the DNP essentials. The proposed project will help in the delivery of evidence-based care that will ensure care providers offer guidance to patients in complex health situations.

Practice Setting and Target Population/ Community

African Americans are considered to be among the subpopulations located in rural areas and inner cities hence, the adoption rates of telehealth are significantly low.  Research participants from this community will be involved in the proposed project to ensure that the research problem is addressed. With a high prevalence of illnesses in the primary care setting among the target community, the will be a suitable environment to carry out the study.  The study will respond to various management programs that can be used in primary care to improve telehealth in the African American community. The project’s practice setting will adopt a PICOT concept to help in effective element identification for the clinical research topic. The setting will ensure collaboration between the researcher and the target population to ensure the findings and recommendations of this project are credible and reliable. Interventions for the proposed project will ensure to improve healthcare in the target population by exploring ways that will increase telehealth adoption rates. The practice setting will involve policy development to ensure the needs of the African American community are met to the utmost satisfaction. It is a setting that will help in improving healthcare quality through the incorporation of technology thus will be in line with the missions and goals of the practice site.

Key Stakeholders

To ensure the proposed project is a success, a collaboration between key stakeholders will essential.  Caregivers, patients specifically from the target population and advocacy groups to ensure the protection of research participants will be among the key stakeholders in the proposed project. Key stakeholders will ensure the achievement of the project’s goals and effective implementation of relevant research initiatives aimed at improving telehealth in the target population. Care providers will include system developers and suppliers, nurses and doctors who will offer research guidelines and will be provided with the recommendations for implementation. Key stakeholders in the proposed project will help in breaking down and defining the project’s goals and help in deciding who will participate in the research. Key stakeholders will closely be involved during the projects dissemination phase to ensure the quality of findings is assessed.

Needs Assessment

In 2018, the American Hospital Association (AHA) stated that telehealth adoption in hospitals increased from 35% to 76%, however, low rates of adoption of telehealth among the African American population is still low and not fully addressed. Improved access to healthcare services and information in this community can be achieved through improved telehealth (Zullig et al., 2018). With the target population taking 13.4% of the total population in the US, notable challenges affecting the target community include low-quality healthcare, racism and inequality. This calls for the need to carry out studies aimed at improving the healthcare quality and ensure equality which can be done through improved implementation of management programs by use of technology. The current healthcare quality in the African American community will help in determining the need for assessment focusing on the primary care setting to be in line with the elements of the projects.

Review of Literature

The proposed project will rely on databases for review of literature that will include the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, PubMed and Cochrane Library. The databases will help in gathering credible and evidence-based information for review of literature, full-text search and peer-reviewed articles. Keywords to be used in the search will include Telehealth, Telemedicine, Quality Improvement, Primary care and Management programs.

Improved access to healthcare information and services in the African American community can be achieved through improved telehealth (Zullig et al., 2018). Authors of this research state that there is a low rate of acceptability of telehealth among the African American community. Zullig et al., (2018) identifies a few cases of interventions for adherence to medications and highlights telehealth as an intervention to improve the adherence. The level 1 systematic review provided means of improving the quality of healthcare in the primary care setting through better management programs by the use of technology. This research involved low income and Medicaid patients with different conditions under care management from different geographical locations. As per this research, it is necessary for a contemplative adaptation of plans for the better telehealth in the primary care for the conveying of clinical trials in primary care. The author states that it is attainable and achievable to implement proper management programs to improve telehealth among the African-American community in compliance with the evidence-based interventions and of positive effect to the management of diseases in the primary care. The research shows that the main goal of health care and clinical research interventions in improving the patients’ health and also the delivery of information and services. It is vital to ensure the identification of proper intervention to ameliorate telehealth.

According to Nelson et al., (2019), there is little knowledge on why proper casual intervention techniques aiming at improving the quality of healthcare through strengthened telehealth in the healthcare delivery are not fully embraced. In populated areas, for instance, the African-Americans who are mostly affected by problems of healthcare access, telehealth mostly the use of phones in the healthcare delivery was necessary for the management of different diseases in the African-American population. It was noted that in the determination of barrier effects or other interventions little or no evidence was available. This was attributed by the inadequate research and also the methodological limitations brought up by the existing researches (Nelson et al., 2019).

According to Qian et al., (2019), a study review done on the implementation of telehealth in the primary care management suggested that affiliation of telehealth in the health-related services and information can greatly improve the adherence of patients to the set prescriptions. The best approach to enhance independence in the management of illness in the primary care setting was the use of technology in the delivery of care. Moreover, with the complexity and the nature of resources required in the use of technology, to maintain and better the technology used in the delivery of care to patients support from dedicated care providers will be needed. The purpose of this research was to show a summary of the evidenced-based literature that assess the productiveness of improved telehealth management programs for patients outcome improvement.

According to Hueneke et al., (2019), the access to Information and healthcare services in a primary care setting is seen as a multidimensional issue that has led to long waiting times that have negatively affected the patients’ results. Through improved telehealth, the long waiting times have been shortened and improved the management of diseases through access to healthcare by telehealth. Certain management programs for improving telehealth have been identified, they include; implementation of public health-related applications, administration of health education interventions and planning of educational interventions. The research was a pre/post survey done to create the utilization of telehealth in diseases management. To reduce the time and cost used in finding healthcare services and information among all communities, the use of telehealth to improve access and the management of diseases in a primary care setting is the most effective means (Heueneke et al., 2019). It is a step in designed to support and improve healthcare education, administration activities and patient care. By enhancing education and awareness, the quality of care to patients will be improved and this is incorporated with increased patient convenience in healthcare. The research showed a difference between the cost incurred by patients in telehealth visits and that of person-visits. In the in-person visits, patients incurred a cost of $6,175 while the use of telehealth-visits in the diseases management patients incurred a cost of $1,005. Statistics according to this study showed the importance of implementing management programs to improve telehealth in the African-community.

According to Brearly et al., (2020), a study on the use of telehealth in the management of psychiatric illness indicated that the use of technology in the delivery of care in mental follow-up was prompted and was seen as more suitable than that of the on-site appointments. The research included an interdisciplinary team that was concerned with the delivery of care through the use of technology which included the implementation of secure messaging and self-help applications. In this study, there was an adoption of the self-care theory since the patients were required to use the self-help applications to improve the patient outcomes. The research went on explaining the initial implementation and outcomes of the interdisciplinary telehealth healthcare facilities. It is clear that technology has created opportunities that ensure the increase in access to improved healthcare facilities in primary care (Brearly et al., 2020).  The use of technology in the delivery of healthcare is significant in the increase of participation in primary care and has led to a decrease in patient problems in accessing healthcare information and services. The study highlighted that there was a reduction of time wastage by the patient which, in turn, led to greater patient satisfaction and this was brought up by improvement of the telehealth in a given community. Among the population, there was a reduction in the burden of diseases symptoms in the illness management which in turn addressed the diagnosis needs which included the management of medications and all this was due to the use of telehealth.

According to List et al., (2019), an improved framework should be provided to ensure proper pedagogical approaches by the care providers when management programs that aim at improving telehealth in a given community are implemented. The authors also highlighted that the care providers will be able to increase their potential in the delivering high-quality care services for the communities in the remote areas as well as the inner cities, for instance, the African-Americans. Also, the systems used in delivering care services using telecommunication and electronic technology will be expanded by improving telehealth in primary care.  According to List et al., (2019), it was necessary to educate and pass knowledge future care providers because technology changes and expands which means it is prompted to evolving care delivery methods and payments. As per the American Hospital Association (AHA), 65% of the hospitals in the United States technological techniques were used to enhance communication between the care providers and patients remotely. It highlighted that most of the hospitals could monitor their patients’ capabilities as well as their recovery process.

Theoretical framework for the project

The Plan-Do-Study-Act (PDSA) model will be applied in presenting the formal framework in the creation of this study since it is a quality improvement project. In the documentation of change test, it will be an essential tool. The model is not focused on developing new systems but instead, it is aimed at bettering the current systems in the organizations. In assessing the essential required project characteristics that will be of great help in improving telehealth among the African-American community, the model will be suitable.

The model will help in the improvement and the documentation of the test of change of the project. The model will contain worksheets and each will be filled for the tests done. Since the changes will go through the cycles of the model and that will help in testing the various changes. For easier identification of the changes that may occur and lead to the improvement of telehealth in the African-American community, a file for all the PDSA worksheets will be kept. The model will be applied in the determination on whether the identified changes will address the effects it has brought and need to be refined to improve the delivery of primary care. The model comes with certain advantages concerning the research, for instance, finding flexibility, minimizing resistance and increased confidence. The key agenda in the improvement of the healthcare industry is the implementation of management programs. Through this model, it will be easier identifying the methods to be used in improving the implementation.

This theoretical framework will be of great significance in easier identification of the researchers main objective, how the researcher will distinguish an improvement from a change and which change will result to an improvement in the implementation of telehealth in the target community. For this project, Lewin’s change theory will be applicable. The study will be attributed by the identification of the changes that will lead to improvement as stated in the description. This theory is explained by concepts, for example, equilibrium, driving forces and restraining forces. The driving forces are identified as those that result in the happening of change or improvement while the restraining forces are the forces that combat the driving forces. Through this theory, the researcher will be able to understand the barriers that will be faced on improving healthcare and also it will be easier to address them. The targeted community and healthcare settings will gradually embrace the technological techniques of patient information and service delivery through the use of certain strategies such as patient education on the importance of telehealth and enhanced awareness. It will use Roy’s adaption theory in following up of the acceptability rates and highlight the continuous process of adoption of management programs focusing on improving telehealth, with the idea of that the targeted community ought to implement the methods of improved telehealth management programs. This model will be of great help in establishing the process of adoption of the new and improved ways of healthcare services delivery. In this research, the known operational variables will be of value in the scrutinizing of the research topic.

The most effective strategies on improving telehealth were identified as educating the clinic personnel on the different techniques of putting in place the management programs in primary care among the targeted community and enhanced awareness on the importance of telehealth. The PDSA model will be effective in following up the research niches in improving telehealth in the targeted community, therefore, it is the perfect option for the study’s structure. Active participation of the researcher will be required in this model where all the stakeholders involved will also be actively engaged to establish accurate and credible data. Also, the researcher will get an extensive approach to telehealth improvement through the implementation of more effective management programs. A synthesized collection of Evidenced-Based Project information to support the research question will consist of the study.

Project Implementation

In the implementation, identification of the problem will be the first step. The phase will consist of identifying and formulating the research topic. Through this, a greater emphasis will be placed on the projects’ characteristics that decide the required necessities. This step will assist in easier identification of niches brought up in the research topic. Other steps in the implementation plan such will include a search strategy which will consist of an extensive search of appropriate literature. It is essential to familiarize with what other researchers have said on the research topic as this will help in getting the useful elements of the project topic (George et al., 2018). In the implementation plan, the involvement of research participants from the targeted community will be entailed and this will make sure that the interventions are established on the participants to follow up the effect. The results produced will be used to decide on whether the interventions are effective and if they will assist in the ways of offering better and improved quality of health by the use of telehealth.

The study is directed to happen four to five months of assessing the efficiency of improving the quality of health in the target community and the implementation of the interventions. Through-out the research process, the human research participants’ rights will be protected and respected. This means that the patient will have a consent of their involvement in the project therefore, they will have the freedom and choice to back out if they wish to. The research participants will be required to fill a consent form which is approved and signed by the Institution Review Board (IRB). Any obtained data and information about the research participants will be kept confidential and will be kept away from unauthorized people. Questionnaires will be used in the project as the instrument in collection of data. It will be in form of a paper questionnaire and it will consist of questions that will help in obtaining the efficiency of the intervention. The research participants will be required to fill in the closed questionnaire and later will be used for analysis. Extensive assessments of the research participants’ responses will be entailed in the data analysis. This will enable the researcher to comprehensively follow up if the implementation of interventions, for instance, patient education on the adoption of telehealth management programs and enhanced awareness focus on improving the quality of care. To help in following up on the necessity to improve the quality of healthcare in the targeted community, the effects of the interventions will be used. With the nature of the project clear, the project will be sustainable since it will show the techniques of management programs in telehealth that will result in improvement in the quality of healthcare.

Project evaluation

The project evaluation will focus on making sense of the management programs as well as the implementation of their effects on healthcare after improving the healthcare quality services. Identifying possible strengths and weakness of the study will be entailed in the evaluation phase. The outcome will be evaluated and from these, the results obtained from those participants who were involved in the research and went on implementing the interventions of the project and those who did not will be differentiated. The data and information collected will be used to monitor the performance of the interventions since it is essential in informing the activities of the evaluation. By evaluating the project the researcher will be able to identify the key aspects of improving the healthcare quality. Incorporation of patient reminder calls, patient education and patient awareness will be the interventions to attribute the management programs for improving the quality of healthcare. The analysis will assist in following up of the efficiency in improving the quality of healthcare among the African-American community hence, extensively highlighting the research topic.

Plan for Dissemination of Information

The distribution of results to the vital stakeholders will be done to the telehealth committee and administration at the programmed meetings that will be happening every month. In the setting of lunch and learn, an oral presentation will be done and this will be out of a request from the mentioned speakers. The dissemination will offer the research introduction, significance, nature, background, the process of data collection and analysis, findings and recommendations. In the dissemination stage, more time will be allocated for the presentation of questions, more discussions or any other relevant concerns. The dissemination plan of information will make sure an interactive and open environment in which all raised concerns will be addressed. Opportunities will be created for future researchers in the field of telehealth ad management programs designed to improve its adoption in the African-American community through the discussion of the project.

Moreover, the project’s dissemination will be done to the stakeholders at higher levels of practice in both local meetings and regional conference organizations. It is in this process, the project will make sure that awareness and education precisely to the staff will be enhanced which in turn will greatly assist in improving the management program in primary care in telehealth among the African-American population. The distribution process will be open and transparent to the mentioned stakeholders who include the patients, the staff and the clinic personnel hence, ensuring the involvement of the whole practice team.