Key Characteristics for Successful Adoption and Implementation of Home Telehealth Technology in Veterans Affairs Home-Based Primary Care: An Exploratory Study
Key Characteristics for Successful Adoption and Implementation of Home Telehealth Technology in Veterans Affairs Home-Based Primary Care: An Exploratory Study
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DOI：
10.1089/tmj.2018.0009
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发表时间：
2019-04-01
影响因子：
4.7
通讯作者：
Edes, Thomas E.
中科院分区：
文献类型：
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作者：
Dang, Stuti;Ruiz, Diana I.;Edes, Thomas E.
背景/目的：退伍军人事务部（VA）以家庭为基础的初级保健（HBPC）项目为超过37,000名高风险、高需求、医疗复杂和昂贵的患者提供在家护理。退伍军人管理局的家庭远程医疗（HT）计划可以潜在地提高HBPC的效率和覆盖面，但关于HBPC中HT的使用和经验的数据很少。这项探索性研究旨在提供HBPC中HT使用的一瞥，并确定HT实施的驱动因素和障碍。设计：国家VA数据用于评估HBPC患者同时使用HT。我们对HBPC项目主管进行了横断面调查，以探索HT的使用，了解沟通过程，并征求公开意见。对18名HBPC项目主管进行了半结构化访谈，他们使用了不同的HT，以澄清主题并了解HBPC使用HT的经验。结果：2011年，15%的HBPC患者使用了HT，不同的HBPC部位使用HT的情况差异很大。全国调查和半结构化访谈显示，大多数HBPC工作人员认识到使用HT的优势，包括提高患者参与度和工作效率。成功采用远程医疗的地点的关键做法包括，HT工作人员参加HBPC会议，并评估所有HBPC患者的HT情况。结论：HBPC中有效的HT整合还有很多工作要做。改善HT和HBPC项目之间的沟通和建立确定适合HT患者的系统至关重要。未来的研究需要描述操作流程并收集有关HT在HBPC中的附加价值的数据，以指导基于证据的HT在VA和Medicare HBPC计划中的整合。
Background/Objectives: The Department of Veteran Affairs (VA) Home-Based Primary Care (HBPC) program provides care to over 37,000 high-risk, high-need, medically complex, and costly patients in their home. The VA's Home Telehealth (HT) program can potentially amplify HBPC's efficiency and reach, yet scarce data on use and experience with HT in HBPC exist. This exploratory study sought to provide a glimpse of HT use in HBPC and identify drivers and barriers for HT implementation. Design: National VA data were used to evaluate HBPC patients concurrently using HT. We conducted a cross-sectional survey of HBPC program directors to explore HT use, understand communication processes, and elicit open comments. Semistructured interviews were conducted of 18 HBPC program directors with varying HT use to clarify themes and understand HBPC experience with HT. Results: Fifteen percent of the overall HBPC patients used HT in 2011, with a wide variation in HT use by HBPC site. The national survey and semistructured interviews revealed that most HBPC staff recognized advantages of using HT, including increased patient engagement and staff efficiency. Crucial practices among sites with successful telehealth adoption included HT staff attending HBPC meetings and evaluating all HBPC patients for HT. Conclusion: Much remains to be done for effective HT integration in HBPC. Improving communication between HT and HBPC programs and establishing a system for identifying suitable patients for HT are vital. Future studies need to delineate operational processes and gather data on the added value of HT in HBPC to guide evidence-based integration of HT in VA and Medicare HBPC programs.