Enhancing Implementation of Telehealth for Veterans w/SCI/D

Edward Hines Jr Va Hospital, Hines IL

Investigators

Abstract

Background/Rationale: There are over 250,000 individuals with spinal cord injuries and disorders (SCI/D) in the United States. There are approximately 42,000 Veterans with SCI/D, and at least half of those Veterans have utilized VA healthcare in recent years. The SCI/D system of care provides comprehensive, life-long services to Veterans with SCI/D through a hub and spokes system of care that includes 24 SCI centers (hubs) and 134 facilities (spokes) that have SCI primary care teams. Veterans with SCI/D may frequently use healthcare to prevent and treat complications from their SCI/D, and for prevention and management of chronic diseases such as diabetes. Across VA, telehealth programs have been implemented to allow Veterans to access services in their home and at clinics or facilities that are closer to home than the nearest SCI Center. Clinical video telehealth (CVT) programs allow patients to communicate with providers in their home or between different health care facilities. Understanding the issues associated with implementing CVT SCI centers and in the spoke sites will provide the basis for future work to enhance implementation. Objectives: The long-term goal of our proposed work is to improve the quality of life of Veterans with SCI/D by developing an SDP to facilitate CVT implementation. Our specific aims are to: (1) Characterize approaches to using CVT for providing services to Veterans with SCI/D; (2) Describe the best practices and challenges associated with implementing different models of CVT for Veterans with SCI/D; and (3) Identify potential strategies that could be used to enhance implementation, such as a toolkit. Methods: This is a multifaceted mixed-methods study. In aims 1 and 2 we will examine the range of factors that relate to the implementation of CVT to enhance care for Veterans with SCI/D. Data sources and analysis activities for the first aim include semi-structured telephone interviews with SCI telehealth coordinators and additional health care providers at SCI centers and at spoke sites. We will select a few sites for more in-depth case studies. To determine the practices that are most effective for increasing and enhancing telehealth use, we will present the findings from the first two aims to an advisory committee. The committee will assist with the development of strategies to increase implementation of CVT use in SCI/D. Impact: The goal of our proposed work is to enhance access to care for Veterans with SCI/D by developing an SDP to facilitate implementation of telehealth strategies. The results of our investigations to address Aims 1 and 2 will inform our meetings with key stakeholders to develop implementation strategies that will be tested in a future project.