The rapid spread of the COVID-19 pandemic has presented the biggest emergency that the healthcare system has ever endured in modern time, requiring a fast-acting response unlike anything the public health field has experienced. While health systems typically have disaster plans in place, most were designed for short-term events, such as natural disasters and mass casualties. The Medical University of South Carolina (MUSC) in Charleston had a well-developed and -tested disaster plan including Virtual Urgent Care that offered free telehealth consultation and screenings when in-person visits were not feasible. In the initial weeks of the pandemic, MUSC set up four telehealth programs through collaboration across multidisciplinary teams and strategic planning. However, MUSC did not expect the diverse needs and high volume of services during the transition. An extensive evaluation of the telehealth programs will provide insights to increase capacity and address barriers for future challenges.

This research aims to examine and improve the implemented telehealth programs and innovations in response to the COVID-19 pandemic. In particular, this research will evaluate the capability of the programs to address patient and medical provider safety along with the delivery of high-quality care. The evaluation of the four telehealth programs will include ongoing observation for any shortcomings in program implementation, and identify ways to reduce potential disparities.

The specific aims of the research are as follows:

• Describe characteristics of programmatic interventions in screening, testing, and treatment and how the urgent COVID-19 requirements modified the standard telehealth or health systems processes. 
• Measure and compare the health system’s COVID-19 adjustments with regards to: overall patient volumes, service uptake, delivery learning curves, and safety/quality indicators as they changed over time, with emphasis on differences observed for underserved and high-risk populations. 
• Assess population health outcomes, value, and cost from the perspectives of patients and providers with special attention to changes in access to acute care, emerging gaps in preventive care, unintended consequences of COVID-19 responses, differential effect on underserved and high-risk populations, and specific issues emerging in rural locations and in broadband “digital deserts.” 

This research will evaluate the four MUSC telehealth programs launched during COVID-19: 1) virtual urgent care screening, 2) remote patient monitoring for COVID-19 positive patients, 3) continuous virtual monitoring to reduce workforce risk and utilization of personal protective equipment, and 4) the transition of outpatient care to telehealth. The research team will conduct retrospective longitudinal data analyses on the MUSC Health System and South Carolina State-level cohorts, administrative systems records abstraction, and prospective interviews to examine system responses, patient, and provider insights regarding the implementation impact. In a four-wave dissemination plan, the team will deploy a range of dissemination methods to reach internal and external audiences.

The goal of this research is to provide evidence needed to evolve patient care post-COVID-19 to ensure the highest quality of care, support changes in payment regulations, reduce the health disparities that are currently present with the delivery of telehealth services, and promote equal access for all.