Maya N Hatch1,2, Rachael N Martinez3, Bella Etingen3, Bridget Cotner4,5, Timothy P Hogan6,7, Itala M Wickremasinghe8, Jennifer Sippel8, Bridget M Smith3,9. 1. Spinal Cord Injury/Disorder Center, Long Beach Veterans Affairs (VA) Medical Center, Long Beach, CA, USA. 2. Physical Medicine & Rehabilitation Department, UC Irvine School of Medicine, Irvine, CA, USA. 3. Edward Hines Jr. Department of VA Hospital, Center of Innovation for Complex Chronic Healthcare, Chicago, IL, USA. 4. Rehabilitation Outcomes Research Section, Research Service, James A. Haley VA Medical Center, Tampa, FL, USA. 5. Department of Anthropology, University of South Florida, Tampa, FL, USA. 6. Center for Healthcare Organization and Implementation Research, Edith Norse Rogers Memorial VA Hospital, Bedford, MA, USA. 7. Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA. 8. U.S. Department of Veterans Affairs, Spinal Cord Injuries and Disorders System of Care Program Office, Seattle, WA, USA. 9. Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Abstract
BACKGROUND: Individuals with spinal cord injuries and disorders (SCI/D) require frequent interdisciplinary health care to address impairments in mobility, autonomic function, and secondary complications. Telehealth has the capacity to substantially transform health care delivery and improve care by increasing access and communication. However, relatively little is known about telehealth use in this specific population. Here we attempt to fill part of this gap. OBJECTIVE: To investigate the frequency and characteristics associated with telehealth use in Veterans with SCI/D. DESIGN: Cross-sectional, descriptive project. SETTING: Veterans Health Administration (VHA) facilities. PARTICIPANTS: A total of 15 028 Veterans living with SCI/D who received services from the VHA SCI/D System of Care. INTERVENTION: Not applicable. OUTCOME MEASURES: Frequency and characteristics associated with VHA telehealth utilization. RESULTS: Of the 15 028 Veterans with SCI/D included in the evaluation, 17% used some form of telehealth in VHA Fiscal Year (FY)2017. Veterans older than 65 years of age had lower odds (odds ratio [OR] = 0.88, P < .05, confidence interval [CI] 0.80-0.98) of using telehealth. Being Caucasian (OR = 1.29, P < .01, CI 1.09-1.52), living in rural areas (OR = 1.16, P < .01, CI 1.05-1.28), living greater distances away from the VHA (P < .01 for all distances), and being in priority group 8, meaning that Veterans have higher copayment requirements (OR = 1.46, P < .001, CI 1.19-1.81), were all significantly associated with greater odds of telehealth use. The most frequent types of telehealth used were real-time clinical video and store-and-forward between a provider and patient within the same hub network. CONCLUSION: There are opportunities to increase telehealth adoption in the SCI/D arena. The findings from this project highlight which Veterans are currently using telehealth services, as well as gaps regarding telehealth adoption in this population.
BACKGROUND: Individuals with spinal cord injuries and disorders (SCI/D) require frequent interdisciplinary health care to address impairments in mobility, autonomic function, and secondary complications. Telehealth has the capacity to substantially transform health care delivery and improve care by increasing access and communication. However, relatively little is known about telehealth use in this specific population. Here we attempt to fill part of this gap. OBJECTIVE: To investigate the frequency and characteristics associated with telehealth use in Veterans with SCI/D. DESIGN: Cross-sectional, descriptive project. SETTING: Veterans Health Administration (VHA) facilities. PARTICIPANTS: A total of 15 028 Veterans living with SCI/D who received services from the VHA SCI/D System of Care. INTERVENTION: Not applicable. OUTCOME MEASURES: Frequency and characteristics associated with VHA telehealth utilization. RESULTS: Of the 15 028 Veterans with SCI/D included in the evaluation, 17% used some form of telehealth in VHA Fiscal Year (FY)2017. Veterans older than 65 years of age had lower odds (odds ratio [OR] = 0.88, P < .05, confidence interval [CI] 0.80-0.98) of using telehealth. Being Caucasian (OR = 1.29, P < .01, CI 1.09-1.52), living in rural areas (OR = 1.16, P < .01, CI 1.05-1.28), living greater distances away from the VHA (P < .01 for all distances), and being in priority group 8, meaning that Veterans have higher copayment requirements (OR = 1.46, P < .001, CI 1.19-1.81), were all significantly associated with greater odds of telehealth use. The most frequent types of telehealth used were real-time clinical video and store-and-forward between a provider and patient within the same hub network. CONCLUSION: There are opportunities to increase telehealth adoption in the SCI/D arena. The findings from this project highlight which Veterans are currently using telehealth services, as well as gaps regarding telehealth adoption in this population.