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Garvin LA, Hu J, Slightam C, McInnes DK, Zulman DM. Use of Video Telehealth Tablets to Increase Access for Veterans Experiencing Homelessness. J Gen Intern Med 2021; 36:2274-2282. [PMID: 34027612 PMCID: PMC8141357 DOI: 10.1007/s11606-021-06900-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Veterans experiencing homelessness face substantial barriers to accessing health and social services. In 2016, the Veterans Affairs (VA) healthcare system launched a unique program to distribute video-enabled tablets to Veterans with access barriers. OBJECTIVE Evaluate the use of VA-issued video telehealth tablets among Veterans experiencing homelessness in the VA system. DESIGN Guided by the RE-AIM framework, we first evaluated the adoption of tablets among Veterans experiencing homelessness and housed Veterans. We then analyzed health record and tablet utilization data to compare characteristics of both subpopulations, and used multivariable logistic regression to identify factors associated with tablet use among Veterans experiencing homelessness. PATIENTS In total, 12,148 VA patients receiving tablets between October 2017 and March 2019, focusing on the 1470 VA Veterans experiencing homelessness receiving tablets (12.1%). MAIN MEASURES Tablet use within 6 months of receipt for mental health, primary or specialty care. KEY RESULTS Nearly half (45.9%) of Veterans experiencing homelessness who received a tablet had a video visit within 6 months of receipt, most frequently for telemental health. Tablet use was more common among Veterans experiencing homelessness who were younger (AOR = 2.77; P <.001); middle-aged (AOR = 2.28; P <.001); in rural settings (AOR = 1.46; P =.005); and those with post-traumatic stress disorder (AOR = 1.64; P <.001), and less common among those who were Black (AOR = 0.43; P <.001) and those with a substance use disorder (AOR = 0.59; P <.001) or persistent housing instability (AOR = 0.75; P = .023). CONCLUSIONS Telehealth care and connection for vulnerable populations are particularly salient during the COVID-19 pandemic but also beyond. VA's distribution of video telehealth tablets offers healthcare access to Veterans experiencing homelessness; however, barriers remain for subpopulations. Tailored training and support for these patients may be needed to optimize telehealth tablet use and effectiveness.
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Affiliation(s)
- Lynn A Garvin
- VA Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 S. Huntington Avenue, Bldg 9, Rm 225, Boston, MA, 02130, USA.
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.
| | - Jiaqi Hu
- VA Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Cindie Slightam
- VA Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - D Keith McInnes
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
- VA Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Donna M Zulman
- VA Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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2
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Jacobs J, Ferguson JM, Van Campen J, Yefimova M, Greene L, Heyworth L, Zulman DM. Organizational and External Factors Associated with Video Telehealth Use in the Veterans Health Administration Before and During the COVID-19 Pandemic. Telemed J E Health 2021; 28:199-211. [PMID: 33887166 DOI: 10.1089/tmj.2020.0530] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To identify organizational and external factors associated with medical center video telehealth uptake (i.e., the proportion of patients using telemedicine) before and early in the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: We conducted a retrospective, observational study using cross-sectional data for all 139 U.S. Veterans Affairs Medical Centers (VAMCs). We used logistic regression analyses to identify factors that predicted whether a VAMC was in the top quartile of VA Video Connect (VVC) telehealth uptake for primary care and mental health care. Results: All 139 VAMCs increased their VVC uptake at least 2-fold early in the pandemic, with most increasing uptake between 5- and 10-fold. Pre-COVID-19, higher VVC uptake in primary care was weakly and positively associated with having more high-risk patients, negatively associated with having more long-distance patients, and positively associated with the prior fiscal year's VVC uptake. During COVID-19, the positive association with high-risk patients and the negative association with long-distance patients strengthened, while weaker broadband coverage was negatively associated with VVC uptake. For mental health care, having more long-distance patients was positively associated with higher VVC uptake pre-COVID-19, but this relationship reversed during COVID-19. Discussion: Despite the marked increase in VVC uptake early in the COVID-19 pandemic, significant VAMC-level variation indicates that VVC adoption was more difficult for some medical centers, particularly those with poorer broadband coverage and less prior VVC experience. Conclusions and Relevance: These findings highlight opportunities for medical centers, VA Central Office, and other federal entities to ensure equitable access to video telehealth.
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Affiliation(s)
- Josephine Jacobs
- Health Economics Resource Center, and Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Divisions of Primary Care and Outcomes Research and Stanford University School of Medicine, Stanford, California, USA
| | - Jacqueline M Ferguson
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Divisions of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - James Van Campen
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Divisions of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Maria Yefimova
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Divisions of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA.,Office of Research Patient Care Services, Stanford Health Care, Stanford, California, USA
| | - Liberty Greene
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Divisions of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Leonie Heyworth
- Office of Connected Care/Telehealth, Department of Veterans Affairs Central Office, Washington, District of Columbia, USA.,Department of Medicine, University of California, San Diego School of Medicine, San Diego, California, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Divisions of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
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Scott BK, Miller GT, Fonda SJ, Yeaw RE, Gaudaen JC, Pavliscsak HH, Quinn MT, Pamplin JC. Advanced Digital Health Technologies for COVID-19 and Future Emergencies. Telemed J E Health 2020; 26:1226-1233. [PMID: 32456560 DOI: 10.1089/tmj.2020.0140] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has led to a national health care emergency in the United States and exposed resource shortages, particularly of health care providers trained to provide critical or intensive care. This article describes how digital health technologies are being or could be used for COVID-19 mitigation. It then proposes the National Emergency Tele-Critical Care Network (NETCCN), which would combine digital health technologies to address this and future crises. Methods: Subject matter experts from the Society of Critical Care Medicine and the Telemedicine and Advanced Technology Research Center examined the peer-reviewed literature and science/technology news to see what digital health technologies have already been or could be implemented to (1) support patients while limiting COVID-19 transmission, (2) increase health care providers' capability and capacity, and (3) predict/prevent future outbreaks. Results: Major technologies identified included telemedicine and mobile care (for COVID-19 as well as routine care), tiered telementoring, telecritical care, robotics, and artificial intelligence for monitoring. Several of these could be assimilated to form an interoperable scalable NETCCN. NETCCN would assist health care providers, wherever they are located, by obtaining real-time patient and supplies data and disseminating critical care expertise. NETCCN capabilities should be maintained between disasters and regularly tested to ensure continual readiness. Conclusions: COVID-19 has demonstrated the impact of a large-scale health emergency on the existing infrastructures. Short term, an approach to meeting this challenge is to adopt existing digital health technologies. Long term, developing a NETCCN may ensure that the necessary ecosystem is available to respond to future emergencies.
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Affiliation(s)
- Benjamin K Scott
- Department of Anesthesiology, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Geoffrey T Miller
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA.,School of Health Professions, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Stephanie J Fonda
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA.,Estenda Solutions, Inc., Conshohocken, Pennsylvania, USA
| | - Ronald E Yeaw
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
| | - James C Gaudaen
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
| | - Holly H Pavliscsak
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
| | - Matthew T Quinn
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
| | - Jeremy C Pamplin
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA.,Departments of Medicine, and Military and Emergency Medicine, Uniformed Services University, Bethesda, Maryland, USA
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Abstract
Objective: This study investigated the safety and efficacy of remote programming of cochlear implants. Study Design: Single-subject design Setting: Four North American clinical sites Patients: Forty cochlear implant recipients aged 12 years or older Intervention: Subjects had their cochlear implants programmed at a location that was remote from their audiologist using telecommunication with and without the support of a facilitator. Main Outcome Measures: Consonant-Nucleus-Consonant (CNC) word scores and the Speech, Spatial, and Qualities of Hearing Scale-C (SSQ-C) were compared using the subject's in-office MAP (program) and MAPs programmed remotely with and without the assistance of a facilitator. Additional subjective preference data were gathered from subjects and audiologists via questionnaires. Results: MAPs programmed via the three different models did not yield significantly different group mean CNC word scores. No device/procedure-related adverse events occurred. SSQ-C questionnaire results indicated that recipients received similar subjective benefit from familiar in-office, remote-facilitated, and remote-unassisted MAPs. Conclusions: Remote programming is an effective means of cochlear implant service delivery. The practice was approved by the FDA on November 17, 2017 supported by the results of this study.
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Wakefield BJ, Vaughan-Sarrazin M. Home Telehealth and Caregiving Appraisal in Chronic Illness. Telemed J E Health 2016; 23:282-289. [PMID: 27631165 DOI: 10.1089/tmj.2016.0105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Remote health monitoring applications are being adopted to improve the health of chronically ill individuals. Little work has focused on the effects of these technologies on informal caregivers (CG) of patients with chronic illnesses. OBJECTIVES To examine differences in caregiving appraisal between CG of enrolled and nonenrolled Veterans in the home telehealth (HT) program. METHODS Cross-sectional survey methodology in 244 dyads (Veteran and CG) from 6 rural Midwestern Veterans Affairs Medical Centers. Survey variables were derived from the 2004 National Alliance for Caregiving survey, along with measures of caregiving strain, burden, and satisfaction. RESULTS We found no differences when comparing HT and non-HT CG. In multivariate analyses combining the two groups, CG characteristics associated with CG strain included younger age, providing help with activities of daily living and instrumental activities of daily living, use of coping skills, depressive symptoms, and less use of unpaid help (all p ≤ 0.001). Burden was associated with CG use of coping skills, caregiving confidence, and relationship quality with the Veteran (all p < 0.0001). CG satisfaction was associated with presence of social support (p < 0.0001). High CG strain was associated with Veteran hospitalization in the combined group (p = 0.03). Burden (p = 0.0002) was significantly associated with CG satisfaction. DISCUSSION Existing HT infrastructure provides an opportunity to incorporate training and support programs for CG of chronically ill patients. Such programs could improve CG confidence and use of positive coping skills, lower strain and burden, and potentially improve the health of both the care recipient and CG.
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Affiliation(s)
- Bonnie J Wakefield
- 1 Center for Comprehensive Access & Delivery Research and Evaluation , Iowa City Veteran's Affairs Healthcare System, Iowa City, Iowa.,2 Rural Health Resource Center-Central Region , Iowa City Veteran's Affairs Healthcare System, Iowa City, Iowa.,3 Sinclair School of Nursing, University of Missouri , Columbia, Missouri
| | - Mary Vaughan-Sarrazin
- 1 Center for Comprehensive Access & Delivery Research and Evaluation , Iowa City Veteran's Affairs Healthcare System, Iowa City, Iowa.,2 Rural Health Resource Center-Central Region , Iowa City Veteran's Affairs Healthcare System, Iowa City, Iowa.,4 Department of Internal Medicine, University of Iowa Roy and Lucille Carver College of Medicine , Iowa City, Iowa
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Kummerow Broman K, Vella MA, Tarpley JL, Dittus RS, Roumie CL. Identification of postoperative care amenable to telehealth. Surgery 2016; 160:264-71. [DOI: 10.1016/j.surg.2016.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/27/2016] [Accepted: 02/13/2016] [Indexed: 11/27/2022]
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Kramer GM, Kinn JT, Mishkind MC. Legal, Regulatory, and Risk Management Issues in the Use of Technology to Deliver Mental Health Care. COGNITIVE AND BEHAVIORAL PRACTICE 2015. [DOI: 10.1016/j.cbpra.2014.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Darkins A, Kendall S, Edmonson E, Young M, Stressel P. Reduced Cost and Mortality Using Home Telehealth to Promote Self-Management of Complex Chronic Conditions: A Retrospective Matched Cohort Study of 4,999 Veteran Patients. Telemed J E Health 2015; 21:70-6. [DOI: 10.1089/tmj.2014.0067] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Adam Darkins
- Telehealth Services, Veterans Health Administration, Washington, DC
| | - Stephen Kendall
- Allocation Resource Center, Department of Veterans Affairs, Braintree, Massachusetts
| | - Ellen Edmonson
- Telehealth Services, Veterans Health Administration, Washington, DC
| | - Michele Young
- Allocation Resource Center, Department of Veterans Affairs, Braintree, Massachusetts
| | - Pamela Stressel
- Telehealth Services, Veterans Health Administration, Washington, DC
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Darkins A. The Growth of Telehealth Services in the Veterans Health Administration Between 1994 and 2014: A Study in the Diffusion of Innovation. Telemed J E Health 2014; 20:761-8. [DOI: 10.1089/tmj.2014.0143] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adam Darkins
- Office of Patient Care Services, Veterans Health Administration, Washington, D.C
- Opinions and views expressed in this paper are those of the author and do not represent those of the U.S. Department of Veterans Affairs
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Doarn CR, Pruitt S, Jacobs J, Harris Y, Bott DM, Riley W, Lamer C, Oliver AL. Federal efforts to define and advance telehealth--a work in progress. Telemed J E Health 2014; 20:409-18. [PMID: 24502793 PMCID: PMC4011485 DOI: 10.1089/tmj.2013.0336] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/19/2013] [Accepted: 12/21/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The integration of telecommunications and information systems in healthcare is not new or novel; indeed, it is the current practice of medicine and has been an integral part of medicine in remote locations for several decades. The U.S. Government has made a significant investment, measured in hundreds of millions of dollars, and therefore has a strong presence in the integration of telehealth/telemedicine in healthcare. However, the terminologies and definitions in the lexicon vary across agencies and departments of the U.S. Government. The objective of our survey was to identify and evaluate the definitions of telehealth/telemedicine across the U.S. Government to provide a better understanding of what each agency or department means when it uses these terms. METHODOLOGY The U.S. Government, under the leadership of the Health Resources and Services Administration in the U.S. Department of Health and Human Services, established the Federal Telemedicine (FedTel) Working Group, through which all members responded to a survey on each agency or department's definition and use of terms associated with telehealth. RESULTS AND CONCLUSIONS Twenty-six agencies represented by more than 100 individuals participating in the FedTel Working Group identified seven unique definitions of telehealth in current use across the U.S. Government. Although many definitions are similar, there are nuanced differences that reflect each organization's legislative intent and the population they serve. These definitions affect how telemedicine has been or is being applied across the healthcare landscape, reflecting the U.S. Government's widespread and influential role in healthcare access and service delivery. The evidence base suggests that a common nomenclature for defining telemedicine may benefit efforts to advance the use of this technology to address the changing nature of healthcare and new demands for services expected as a result of health reform.
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Affiliation(s)
- Charles R. Doarn
- NASA Headquarters, Washington, D.C
- Department of Family and Community Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sherilyn Pruitt
- Office for the Advancement of Telehealth, U.S. Department of Health and Human Services, Rockville, Maryland
| | | | - Yael Harris
- Division of Healthcare Quality Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Rockville, Maryland
| | - David M. Bott
- Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services, Baltimore, Maryland
| | - William Riley
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - Anthony L. Oliver
- Office for the Advancement of Telehealth, U.S. Department of Health and Human Services, Rockville, Maryland
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Davis LE, Coleman J, Harnar J, King MK. Teleneurology: successful delivery of chronic neurologic care to 354 patients living remotely in a rural state. Telemed J E Health 2014; 20:473-7. [PMID: 24617919 DOI: 10.1089/tmj.2013.0217] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Delivery of specialty healthcare to rural citizens in the United States remains largely unmet. The Veterans Health Administration is in a unique position to deliver specialty care to rural Veterans because it is mandated to deliver medical care to all eligible Veterans regardless of residence. To accomplish this, the VHA developed large national telehealth networks that provided over 1 million episodes of care in 2012. We investigated whether clinical video telehealth technologies can provide quality efficient neurologic follow-up care to Veterans living in the rural southwest United States. PATIENTS AND METHODS Veterans with chronic neurologic conditions living remotely in New Mexico, southern Colorado, eastern Arizona, and western Texas were offered follow-up teleneurology care at 11 rural community-based outpatient clinics following initial evaluation at the Albuquerque, NM, neurology outpatient clinic. RESULTS Over a 2-year period, 87% of 354 consecutive patients returned a performance improvement satisfaction questionnaire. Ninety percent of the patients were fully satisfied with their visit, and 92% felt teleneurology saved them time and money. We calculated an average time savings of 5 h and 325 miles driven, plus at least $48,000 total cost savings. Ninety-five percent reported they wanted to continue their neurologic care by teleneurology. CONCLUSIONS Our study confirms earlier pilot studies of successful follow-up care through telemedicine. Our patients were highly satisfied with the convenience and quality of their teleneurology visit, and the neurology providers were convinced that neurologic care to both teleneurology and clinic follow-up patients was equivalent. Teleneurology to rural Veterans can provide quality neurologic care and overwhelming patient satisfaction and save considerable time and money.
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Affiliation(s)
- Larry E Davis
- 1 Neurology Service, New Mexico Veterans Affairs Healthcare System , Albuquerque, New Mexico
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