Karla L Miller1,2,3, Melissa J Steffen4,5,6, Kimberly D McCoy5,6, Grant Cannon7, Aaron T Seaman5,8, Zachary L Anderson4,9, Shardool Patel4,9,10, Janiel Green4,11, Shylo Wardyn5, Samantha L Solimeo5,6,8. 1. VA Office of Rural Health, Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Salt Lake City, UT, USA. Karla.Miller@va.gov. 2. Department of Internal Medicine, Rheumatology Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA. Karla.Miller@va.gov. 3. Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT, USA. Karla.Miller@va.gov. 4. VA Office of Rural Health, Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Salt Lake City, UT, USA. 5. VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Salt Lake City, UT, USA. 6. Comprehensive Access & Delivery Research and Evaluation (CADRE), Primary Care Analytics Team Iowa City (PCAT-IC), Department of Veterans Affairs, CADRE, Iowa City VA HCS, Research 152, 601 Highway 6 West, Iowa City, IA, 52246, USA. 7. Department of Internal Medicine, Rheumatology Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA. 8. Division of Genera l Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 52242, Iowa City, IA, USA. 9. Department of Anesthesiology, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA. 10. Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA. 11. Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.
Abstract
An informatics-driven population bone health clinic was implemented to identify, screen, and treat rural US Veterans at risk for osteoporosis. We report the results of our implementation process evaluation which demonstrated BHT to be a feasible telehealth model for delivering preventative osteoporosis services in this setting. PURPOSE: An established and growing quality gap in osteoporosis evaluation and treatment of at-risk patients has yet to be met with corresponding clinical care models addressing osteoporosis primary prevention. The rural bone health tea m (BHT) was implemented to identify, screen, and treat rural Veterans lacking evidence of bone health care and we conducted a process evaluation to understand BHT implementation feasibility. METHODS: For this evaluation, we defined the primary outcome as the number of Veterans evaluated with DXA and a secondary outcome as the number of Veterans who initiated prescription therapy to reduce fracture risk. Outcomes were measured over a 15-month period and analyzed descriptively. Qualitative data to understand successful implementation were collected concurrently by conducting interviews with clinical personnel interacting with BHT and BHT staff and observations of BHT implementation processes at three site visits using the Promoting Action on Research Implementation in Health Services (PARIHS) framework. RESULTS: Of 4500 at-risk, rural Veterans offered osteoporosis screening, 1081 (24%) completed screening, and of these, 37% had normal bone density, 48% osteopenia, and 15% osteoporosis. Among Veterans with pharmacotherapy indications, 90% initiated therapy. Qualitative analyses identified barriers of rural geography, rural population characteristics, and the infrastructural resource requirement. Data infrastructure, evidence base for care delivery, stakeholder buy-in, formal and informal facilitator engagement, and focus on teamwork were identified as facilitators of implementation success. CONCLUSION: The BHT is a feasible population telehealth model for delivering preventative osteoporosis care to rural Veterans.
An informatics-driven population bone health clinic was implemented to identify, screen, and treat rural US Veterans at risk for osteoporosis. We report the results of our implementation process evaluation which demonstrated BHT to be a feasible telehealth model for delivering preventative osteoporosis services in this setting. PURPOSE: An established and growing quality gap in osteoporosis evaluation and treatment of at-risk patients has yet to be met with corresponding clinical care models addressing osteoporosis primary prevention. The rural bone health tea m (BHT) was implemented to identify, screen, and treat rural Veterans lacking evidence of bone health care and we conducted a process evaluation to understand BHT implementation feasibility. METHODS: For this evaluation, we defined the primary outcome as the number of Veterans evaluated with DXA and a secondary outcome as the number of Veterans who initiated prescription therapy to reduce fracture risk. Outcomes were measured over a 15-month period and analyzed descriptively. Qualitative data to understand successful implementation were collected concurrently by conducting interviews with clinical personnel interacting with BHT and BHT staff and observations of BHT implementation processes at three site visits using the Promoting Action on Research Implementation in Health Services (PARIHS) framework. RESULTS: Of 4500 at-risk, rural Veterans offered osteoporosis screening, 1081 (24%) completed screening, and of these, 37% had normal bone density, 48% osteopenia, and 15% osteoporosis. Among Veterans with pharmacotherapy indications, 90% initiated therapy. Qualitative analyses identified barriers of rural geography, rural population characteristics, and the infrastructural resource requirement. Data infrastructure, evidence base for care delivery, stakeholder buy-in, formal and informal facilitator engagement, and focus on teamwork were identified as facilitators of implementation success. CONCLUSION: The BHT is a feasible population telehealth model for delivering preventative osteoporosis care to rural Veterans.
Authors: Tina Willson; Scott D Nelson; Jonathan Newbold; Richard E Nelson; Joanne LaFleur Journal: Clin Epidemiol Date: 2015-01-09 Impact factor: 4.790
Authors: Aaron T Seaman; Melissa J A Steffen; Jennifer M Van Tiem; Shylo Wardyn; Xiomara Santana; Karla L Miller; Samantha L Solimeo Journal: Osteoporos Int Date: 2021-08-19 Impact factor: 4.507
Authors: Jennifer M Van Tiem; Melissa J A Steffen; Aaron T Seaman; Karla Miller; Shylo E Wardyn; Christopher C Richards; Samantha L Solimeo Journal: JBMR Plus Date: 2021-05-14