Telehealth at the US Department of Veterans Affairs after Hurricane Sandy

Abstract

Background Like other integrated health systems, the US Department of Veterans Affairs has widely implemented telehealth during the past decade to improve access to care for its patient population. During major crises, the US Department of Veterans Affairs has the potential to transition healthcare delivery from traditional care to telecare. This paper identifies the types of Veterans Affairs telehealth services used during Hurricane Sandy (2012), and examines the patient characteristics of those users. Methods This study conducted both quantitative and qualitative analyses. Veterans Affairs administrative and clinical data files were used to illustrate the use of telehealth services 12 months pre- and 12 months post- Hurricane Sandy. In-person interviews with 31 key informants at the Manhattan Veterans Affairs Medical Center three-months post- Hurricane Sandy were used to identify major themes related to telecare. Results During the seven-month period of hospital closure at the Manhattan Veterans Affairs Medical Center after Hurricane Sandy, in-person patient visits decreased dramatically while telehealth visits increased substantially, suggesting that telecare was used in lieu of in-person care for some vulnerable patients. The most commonly used types of Veterans Affairs telehealth services included primary care, triage, mental health, home health, and ancillary services. Using qualitative analyses, three themes emerged from the interviews regarding the use of Veterans Affairs telecare post- Hurricane Sandy: patient safety, provision of telecare, and patient outreach. Conclusion Telehealth offers the potential to improve post-disaster access to and coordination of care. More information is needed to better understand how telehealth can change the processes and outcomes during disasters. Future studies should also evaluate key elements, such as adequate resources, regulatory and technology issues, workflow integration, provider resistance, diagnostic fidelity and confidentiality, all of which are critical to telehealth success during disasters and other crises.

Implications for Telemedicine for Surgery Patients After COVID-19: Survey of Patient and Provider Experiences

“…Previous studies of telemedicine during natural disasters indicate that virtual encounters can be carried out with a high degree of patient satisfaction. 15,16 While these studies did not focus on surgical care, it is clear that telemedicine systems can be rapidly implemented effectively when circumstances prevent patients from visiting their providers in person.…”

Optimizing Peripandemic Care for Veteran Major Non-Traumatic Lower Extremity Amputees: A Proposal Informed by a National Retrospective Descriptive Analysis of COVID-19 Risk Factor Prevalence

“…The Veterans Affairs Administration has extensive experience and expertise in medical telehealth services and has employed telehealth in previous times of crisis for vulnerable patient populations. 23,24,25 Due to their high risk, all amputees should be counseled on proper sanitation, the importance of social distancing, and monitored for sudden changes or advancement of existing respiratory disease. During postsurgical follow-up it will also be imperative to monitor for possible COVID19 symptoms as an addition to the standard of care.…”

Patient Characteristics of VA Telehealth Users During Hurricane Harvey

“…However, research on the use of telehealth services during disasters is relatively new, and little work has been done examining the patient characteristics of VA telehealth users during major disasters. 20 During Hurricane Harvey, which made landfall near Houston, Texas, at peak intensity on August 25, 2017, many areas in the state received more than 50 inches of rain, causing catastrophic flooding. By focusing on encounter-level data, our previous study 21 examined the use of telehealth services at the Houston VAMC, which remained open during the hurricane.…”