Comparative Analysis of Telehealth vs. In-Person Care in Nursing Outcomes

Thesis Abstract

The rapid expansion of telehealth services in nursing care has created a need to empirically evaluate how remote assessments and interventions compare with traditional in-person care in terms of patient outcomes, clinician workload, and equity of access. This study addresses the problem of limited robust, context-specific evidence on the effectiveness, safety, and patient-centeredness of telehealth-delivered nursing, particularly for chronic disease management and post-discharge follow-up. The aim is to compare nursing outcomes between telehealth and in-person care modalities across multiple health indicators, with specific objectives to (1) evaluate clinical outcomes such as hospital readmission rates, symptom burden, and adherence to care plans; (2) assess patient-reported outcomes including satisfaction, perceived quality of care, and self-efficacy in self-management; (3) examine process measures such as time-to-contact, access to care, and nurse workload; (4) explore differential effects by patient demographics and digital literacy; and (5) identify contextual factors influencing modality effectiveness. The study adopts a mixed-methods, cross-sectional design guided by the Technology Acceptance Model and the Donabedian framework, integrating quantitative analyses with qualitative insights to elucidate mechanisms underlying observed differences. Quantitative data will be collected from 520 adult patients receiving nursing care for chronic conditions (e.g., diabetes, hypertension, heart disease) across five urban and suburban primary care settings over a 12-month period. Participants will be stratified into telehealth and in-person cohorts based on the predominant modality of their care encounters during the study window. Patient-level measurements will include clinical indicators (blood pressure, HbA1c, lipid profiles, readmission within 30 days), validated scales for quality of life (SF-12), self-management (PAM-13), satisfaction (CSQ-8), and digital literacy (eHealth Literacy Scale). Data sources will comprise electronic health records, appointment logs, laboratory results, and patient surveys. Descriptive statistics will summarize characteristics; multivariable regression models and propensity score methods will adjust for confounders such as age, comorbidity, socioeconomic status, and baseline health status. Hierarchical linear modeling will account for clustering by clinic site. Secondary analyses will include time-to-contact and contact frequency using survival analysis and Poisson models, respectively, to evaluate access and efficiency dimensions. A moderation analysis will examine whether digital literacy and age modify the relationship between care modality and outcomes. The qualitative component will involve semi-structured interviews with a purposive sample of 40 patients and 20 nurses from both modalities to explore perceived barriers, facilitators, and contextual factors, analyzed using thematic analysis aligned with the Consolidated Framework for Implementation Research (CFIR). Expected findings anticipate that telehealth will demonstrate non-inferiority to in-person care for key clinical outcomes like 12-month HbA1c and systolic blood pressure control when adequate digital literacy and workflow integration are present, with significant improvements in access and patient satisfaction for rural or mobility-impaired populations. However, disparities may emerge where digital literacy or broadband access is limited, potentially attenuating benefits and widening inequities. Process measures may reveal shorter mean times to first follow-up in telehealth care and higher nurse contact density, yet with potential increases in perceived workload for clinicians in the absence of robust triage protocols. The study will contribute to knowledge by providing contemporary, setting-specific evidence on telehealth efficacy in nursing care, clarifying which patient groups benefit most, and identifying operational determinants that optimize outcomes. The findings will inform policy and practice guidelines regarding hybrid care models, training needs for nurses, and investment in digital infrastructure. The main conclusion will articulate that telehealth can achieve comparable clinical outcomes to in-person care for selected nursing populations when supported by adequate digital literacy, effective care pathways, and organizational readiness. Recommendations include targeted digital literacy interventions, standardized telehealth protocols, clinician training in remote assessment, investment in secure and interoperable health IT systems, and strategies to mitigate inequities, such as subsidized access for low-income patients and outreach programs to improve telehealth engagement in underserved communities. Further research should investigate longitudinal effects, cost-effectiveness analyses, and randomized controlled trials to strengthen causal inferences.