Vet Connect: A Quality Improvement Program to Provide Telehealth Subspecialty Care for Veterans Residing in VA-Contracted Community Nursing Homes
Vet Connect: A Quality Improvement Program to Provide Telehealth Subspecialty Care for Veterans Residing in VA-Contracted Community Nursing Homes
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DOI：
10.3390/geriatrics3030057
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发表时间：
2018-09-01
期刊：
影响因子：
2.3
通讯作者：
Levy, Cari
中科院分区：
文献类型：
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作者：
Hale, Anne;Haverhals, Leah M.;Levy, Cari
居住在退伍军人健康管理局 (VA) 签约社区疗养院 (CNH) 的退伍军人从其居住的 CNH 获得初级护理，但经常前往退伍军人事务医疗中心 (VAMC) 寻求专业护理服务。 Vet Connect 项目是一个质量改进项目，旨在实施视频技术以支持获得专业护理。方法：八名丹佛 VAMC 专业护理人员和三名项目护士接受了远程医疗培训并获得了适当的设备。为了确定适合代替视频就诊的面对面就诊，项目护士会审查 CNH 退伍军人图表，直接咨询退伍军人，并获取工作人员的建议。项目护士在 CNH 内担任电话主持人，而 VA 专家则由 VAMC 提供护理。每次就诊后，团队护士都会与 CNH 工作人员协调护理并向其提供专业护理建议。结果：我们评估了 Vet Connect 项目的临床、业务和技术领域，并利用流程图来确定实施的障碍和促进因素。临床上，从2017年6月26日到2018年6月1日，我们对11个不同的CNH进行了N = 203次视频访问，涉及三个亚专业：老年病学、姑息治疗和心理健康。这些访问为 37 名退伍军人提供了 49 份转介。从财务角度来看，成本分析表明，医疗保健系统每次就诊可节省约 310 美元。从技术上来说，成功率为83%。流程图有助于确定实施远程医疗计划的促进因素和障碍，包括培养主要利益相关者（即医疗和心理健康提供者、远程医疗工作人员和 CNH 工作人员）的支持、允许持续进行计划调整的沟通以及建立关系。结论：在 Vet Connect 计划中使用视频访问技术向疗养院提供亚专业护理是可行的，使用集中组织来协调复杂的临床、业务和技术流程。 Vet Connect 已被证明是可持续的，并且有潜力在 VA 内外扩展。
Veterans residing in Veterans Health Administration (VA) contracted Community Nursing Homes (CNHs) receive primary care from the CNH they reside in, but often travel to Veterans Affairs Medical Centers (VAMCs) for specialty care services. The Vet Connect project is a quality improvement project aiming to implement video technology to support access to specialty care. Methods: Eight Denver VAMC specialty care providers and three project nurses underwent telehealth training and obtained appropriate equipment. To identify in-person visits eligible for substitution of video visits, project nurses review charts of CNH Veterans, consult directly with Veterans, and obtain recommendations from staff. Project nurses serve as tele-presenters within the CNHs, while VA specialists provide care from the VAMC. After each visit, team nurses coordinate care with and deliver specialty care recommendations to CNH staff. Results: We assessed clinical, business, and technical domains of the Vet Connect project, and utilized process mapping to identify barriers and facilitators to implementation. Clinically, starting on 26 June 2017 through 1 June 2018, N = 203 video visits have been conducted with 11 different CNHs in three subspecialties: geriatrics, palliative care, and mental health. These visits generated 49 referrals for 37 Veterans. Fiscally, cost analyses indicate that per visit, the health care system saves an estimated $310. Technologically, the success rate was 83%. Process mapping helped identify facilitators and barriers to implementation of the telehealth program, including cultivating buy-in from key stakeholders (i.e., medical and mental health providers, telehealth staff, and CNH staff), communication allowing for ongoing program adaptation, and building relationships. Conclusion: Subspecialty care delivery to nursing homes using video visit technology in the Vet Connect program is feasible using centralized organization to coordinate complex clinical, business and technical processes. Vet Connect has proved sustainable and has potential to expand within and outside of the VA.