Table 5 Clinic Features Impacting Acceptability of the Specialized COVID-19 Clinic Across Patients and Providers

Access to care – The ease with which patients access services through CROWN

Largely favorable perceptions across patients and providers, particularly given barriers in accessing traditional primary care

“I prefer the CROWN Clinic…because I have to wait a very long time…to talk with my primary care physician. Sometimes they are too busy to answer the phone or especially in, in the time of COVID, they don’t have enough, people to answer the phone…they [CROWN clinic] answered my call right away.” -Patient 9

“…Frankly, just having any single phone number that they know they can reach someone without going to the emergency room, [is] probably the single most important thing. Easy access, well-structured access, as you probably know in healthcare in general, that’s one of the biggest problems, just the friction around access, interacting with a care team when you have a problem.” -Provider 5

Frequency of outreach – The cadence of telephone and video encounters based on the clinic’s risk stratification protocol

Largely favorable perceptions in patients and mixed perceptions in physicians who questioned whether proactive outreach was the best use of scarce resources

“Interviewer: How did you feel about the frequency of these phone calls?

Patient: Very good, because they were following up on my health.” -Patient 2

“I think the risk stratification tool has worked very well for us to determine how often patients need to be followed.”-Provider 3

“I talked to patients along the [entire] risk strata…it seemed to be overkill…if we had [un]limited resources, great, but we have tons of…non-COVID patients that have poor access [to care]…[this is] not the right level for the need, but I think the general idea of a care pathway is a good thing.”-Provider 6

Patient education – Role of CROWN clinicians in providing education regarding the disease

Largely favorable perceptions across patients and providers who felt publicly available information and county outreach fell short of COVID-19 patient needs

“…I could speak with them…I was also able to have my uncertainties addressed and everything and so I could ask questions… and it was good…” –Patient 10

“And then, patients have many questions, for example, about when they can return to work, what to do with their family’s safety, how to access resources that they might need for food or for places for their family to stay and social work type needs. And those questions take a ton of time to answer.” -Provider 7

Specialist COVID-19 team – CROWN clinician expertise in providing COVID-19 care

Largely favorable perceptions across patients who felt their questions were answered relative to other health settings and providers who describe significant time involved in developing and maintaining COVID-19 expertise

“…the doctors, nurses and everybody…they understand everything…I’m still going there …because I’m a research patient too…but I had a very good experience. Everybody is nice. They are taking care of me. They are very responsible. They answered all my questions, so I’m very happy, and I’m very glad with the research [participation].” -Patient 9

“I think you do want to have a small group of people doing it because it does take a while to become familiar with this disease and the workflows. So, I think it’d be hard if every primary doctor had one COVID patient, it’s hard for them to really stay on top of all the data. But …you could absolutely have a group of interested primary care doctors working CROWN clinics.” -Provider 5

Support for mental health needs – Degree to which clinic supports mental health needs, including facilitating connection to behavioral health

Largely favorable perceptions across patients who reported emotional benefit from clinical interaction and providers who responded to loneliness during clinic encounters

“I... wanted to know… what state I was, if it was improving or not …and also, I was always alone in my room, they would talk to me, [laughs] felt like I wasn’t alone.” - Patient 13

“…they would call us… one would feel calmer…it did help me a lot. ...like the information they would give us and…one would do what one was told, ‘you can do this and this’…this helped us…to cope.” -Patient 21

“What I do find, when I see patients in CROWN, is a lot of emotional support. …a lot of these patients have been quarantined from other human beings for the past few weeks, and they’re really lonely. They’re just grateful for the opportunity to sit in front of another human and speak to them.” –Provider 4

Predominant use of virtual encounters – Acceptance of video and telephone encounters as the primary modality of clinical care, with escalation to in-person care only as needed

Mixed acceptance across patients and providers, most of whom recognized need for virtual visits to reduce transmission risk, though some patients preferred in-person encounters to ensure accuracy of physical exam

“…the video call is better because I don’t have to go out or maybe contaminate another different person…[on] my way to the hospital…I don’t like to take that risk” – Patient 09

“[I prefer appointments] in person. See, by phone don’t make no sense to me. So, I go in person I can explain to the doctor it hurt me right here and that’s what happened…It’s a lot different talking in person over talking by phone.”- Patient 12

“I prefer videos when I can because there’s a lot to be gained when you can actually just eyeball a person…” -Provider 1

Incorporation of pulse oximetry – Inclusion of home pulse oximetry for medium and high risk patients with data sharing as a part of a standard protocol

Favorable perceptions across patients and providers who reported it supported decision-making

“Even when I was feeling healthy, I was still using it just to make sure that it didn’t…go below whatever that number, 95, 96 or something… it was straight forward and they sent…an instruction that was very thorough.” -Patient 3

“If a patient tells me they’re feeling short of breath and their pulse ox is below 95, then I want them to come in to recheck the pulse ox with ours and take a listen to their lungs and that kind of thing.” -Provider 8

Support for social needs – Degree to which CROWN was able to meet the social needs of its patients

Favorable perceptions in patients, some of whom reported using these services; mixed perceptions amongst providers, some of whom felt patient needs surpassed what they were able to offer

“Yes, they would always ask me if I needed help to do my grocery shopping, you know, when you need to buy things at the store, but you cannot leave the house, but I would always tell them that I had people helping me.”

- Patient 6

“…some of the social challenges that some of our patients may have… [there are some] that are like, ‘No, I don’t have a doctor. I don’t have a clinic. I don’t have anybody to help me with getting food and water. And I’m living in a hotel.’…In the immediate moment, if I feel like somebody needs something that we cannot get for them at home and I’m worried about them, I direct them to the ER. And I write a note saying why. Whether it be for admission, for socioeconomic issues, or lack of social support or whatnot, or just elderly not going to do well at home, can’t get home health in to check on them.” –Provider 2

Continuity of specialist care – Integration of specialty care into overall care during COVID-19

Unfavorable perceptions in a subset of patients with comorbid disease; mixed perceptions from providers who reported variation in their ability to facilitate specialty care.

“They referred me to my oncologist. My oncologist referred me back to the CROWN clinic, so basically I had people refer me back and forth to one another, but I never got good answers…so my answers are always well its new, well we don’t know much, and I just, I think that’s a cop out.” –Patient 11

“So sometimes, I’m communicating with the specialists to advocate for the patient to be able to come back into their care…I have to talk to the hospital epidemiologist and then loop in…the specialists, and advocate for our patients to be released from isolation at Stanford. And it’s crazy.” - Provider 7