Quality, Safety, Value: Impact of Sudden shift to Telehealth due to COVID-19 within Nurse-led care Models
located in Colorado Rural and Urban Communities
Project Summary
COVID-19 has jeopardized the already precariously positioned US healthcare system, prompting a sudden shift
in the delivery of primary and prenatal care, behavioral health, and public health services to the telehealth
environment for optimized access to care for millions of vulnerable Americans in urban and rural communities.
In Colorado, innovative nurse-led models of care are a vital component of healthcare delivery for the most
ethnically, geographically, and economically vulnerable populations. This is possible through recognized
structures of federally qualified health centers, certified nurse midwifery practices, and the Nurse-Family
Partnership (NFP) home visitation program. The widespread implementation of telehealth is a change in
healthcare delivery that requires systematic study to support within-system learning, rapid adaptation to improve
access and health outcomes, and informed enhancements to ensure sustainability to endure future system
challenges. While evidence supports positive patient outcomes for nurse-led telephonic and telehealth
interventions for specific populations, our integrated and highly skilled team of nurse scientists aims to evaluate,
for the first time, the impact of this urgent and immediate shift from in-person to virtual care for an expanded
array of healthcare services. The long-term goal of leveraging this natural experiment is to evaluate telehealth
to support vulnerable patients seeking nurse-led care within behavioral health, primary and prenatal care, and
home visitation models in urban and rural communities across Colorado. Through statewide network
collaboration, our central hypothesis is that the benefits of nurse-led care will withstand rapid telehealth
implementation in Colorado in response to COVID-19. Using an observational, time series design shaped by
COVID-19 to evaluate and rapidly disseminate within- and between-group telehealth innovations and challenges,
we will inform the evolution of this emerging care model to support those with multiple chronic conditions,
vulnerable populations, and to reduce disparities in care through a lens of intersectionality. Through Aim 1, we
will evaluate the impact of sudden telehealth implementation on statewide healthcare utilization in nurse-led
models of behavioral health, primary/prenatal care, and home visitation in Colorado among ethnically,
geographically, and economically vulnerable populations. In Aim 2, we will further evaluate the consequences
(intended/unintended) of sudden telehealth implementation on patient outcomes following COVID-19. Through
Aim 3, we will characterize the patient and provider experience of sudden telehealth implementation in Colorado
using a mixed method approach involving interviews and surveys. This study will leverage the RE-AIM model
to assess reach, adoption, implementation and maintenance of telehealth with quarterly analysis and
dissemination to participating institutions, allowing for adaptation to negative trends. Analysis of uniform and
patient-level claims data, surveys and interviews will provide evidence to inform delivery of high quality, safe,
accessible, equitable and affordable nurse-led telehealth, scalable for adoption in other regions of the US.
