Stuti Dang1,2,3, Tobie Olsan4,5, Jurgis Karuza4,6,7, Xueya Cai4,8, Shan Gao4,8, Orna Intrator4,9, Jiejin Li4,9, Suzanne M Gillespie4,6. 1. Miami Veterans Affairs Geriatric Research Education and Clinical Center, Miami, Florida. 2. Miami Veterans Affairs Healthcare System, Miami, Florida. 3. Division of Geriatrics and Palliative Care, University of Miami Miller School of Medicine, Miami, Florida. 4. Canandaigua Veteran Affairs Medical Center, Canandaigua, New York. 5. School of Nursing, University of Rochester, Rochester, New York. 6. Division of Geriatrics and Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York. 7. Department of Psychology, Buffalo State College, Buffalo, New York. 8. Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York. 9. Department of Public Health Sciences, University of Rochester, Rochester, New York.
Abstract
OBJECTIVES: To describe the structural characteristics and challenges associated with home telehealth (HT) use in the US Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. DESIGN: We designed a national survey to collect information about HBPC program structural characteristics. The survey included eight organizational and service domains, one of which was HT. HBPC program directors were surveyed online using REDCap. PARTICIPANTS: We received 232 surveys from 394 HBPC sites (59% response rate). METHODS: HBPC structural domains were compared between sites using and not using HT technology. Open-ended responses were analyzed using content analysis. RESULTS: A total of 127 sites (76%) used HT, which was more likely when HBPC sites were aligned organizationally with the VA's Geriatrics and Extended Care Services division, when there were more disciplines on the HBPC team, and when primary care providers made home visits. Program directors overwhelmingly viewed HT as contributing to managing veterans' complex chronic conditions (81%), yet HT data were not readily integrated into care planning (24%). Challenges to HT use included veterans' acceptance and adherence, device issues, and collaboration between HBPC teams and HT staff. CONCLUSION: Corresponding to HBPC's complexity, HT use is primarily a self-organizing process that shapes the patterns of integration at each site. Although HT technology is compatible with core structures of the HBPC model, usability varies, and overall is low. To optimize HT use in HBPC, there are opportunities to redesign systems to mitigate challenges to adoption. As the Centers for Medicare and Medicaid Services' strives to increase access to both HBPC and telehealth benefits, evidenced by the continuation of its successful Independence at Home demonstration and the final changes in the proposed rule in April 2019 incorporating additional telehealth benefits for beneficiaries, this information will be relevant to VA and non-VA alike. J Am Geriatr Soc 67:1928-1933, 2019.
OBJECTIVES: To describe the structural characteristics and challenges associated with home telehealth (HT) use in the US Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. DESIGN: We designed a national survey to collect information about HBPC program structural characteristics. The survey included eight organizational and service domains, one of which was HT. HBPC program directors were surveyed online using REDCap. PARTICIPANTS: We received 232 surveys from 394 HBPC sites (59% response rate). METHODS: HBPC structural domains were compared between sites using and not using HT technology. Open-ended responses were analyzed using content analysis. RESULTS: A total of 127 sites (76%) used HT, which was more likely when HBPC sites were aligned organizationally with the VA's Geriatrics and Extended Care Services division, when there were more disciplines on the HBPC team, and when primary care providers made home visits. Program directors overwhelmingly viewed HT as contributing to managing veterans' complex chronic conditions (81%), yet HT data were not readily integrated into care planning (24%). Challenges to HT use included veterans' acceptance and adherence, device issues, and collaboration between HBPC teams and HT staff. CONCLUSION: Corresponding to HBPC's complexity, HT use is primarily a self-organizing process that shapes the patterns of integration at each site. Although HT technology is compatible with core structures of the HBPC model, usability varies, and overall is low. To optimize HT use in HBPC, there are opportunities to redesign systems to mitigate challenges to adoption. As the Centers for Medicare and Medicaid Services' strives to increase access to both HBPC and telehealth benefits, evidenced by the continuation of its successful Independence at Home demonstration and the final changes in the proposed rule in April 2019 incorporating additional telehealth benefits for beneficiaries, this information will be relevant to VA and non-VA alike. J Am Geriatr Soc 67:1928-1933, 2019.
Authors: Patricia Commiskey; April W Armstrong; Tumaini R Coker; Earl Ray Dorsey; John C Fortney; Kenneth J Gaines; Brittany M Gibbons; Huong Q Nguyen; Daisy R Singla; Eva Szigethy; Elizabeth A Krupinski Journal: J Med Internet Res Date: 2021-09-20 Impact factor: 5.428
Authors: Veronica Rivera; Melissa D Aldridge; Katherine Ornstein; Kate A Moody; Audrey Chun Journal: J Am Geriatr Soc Date: 2020-11-24 Impact factor: 5.562