Telehealth Implementation in a Skilled Nursing Facility: Case Report for Physical Therapist Practice in Washington

Lee, Alan Chong W.; Billings, Michael

doi:10.2522/ptj.20150079

Cited by 23 publications

(17 citation statements)

References 14 publications

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“…While acknowledging that a national policy for investment in eHealth interventions is crucial to its adoption, Rozenblum et al [ 132 ] argued that financial incentives should be based on patient outcomes that might ensue from the eHealth intervention. DeWorsop et al [ 129 ] and Lee and Billings [ 133 ] reported on the importance of cost effectiveness to promoting the adoption of eHealth interventions.…”

Section: Resultsmentioning

confidence: 99%

Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature

Granja¹,

Janssen²,

Johansen³

2018

J Med Internet Res

478

383

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BackgroundeHealth has an enormous potential to improve healthcare cost, effectiveness, and quality of care. However, there seems to be a gap between the foreseen benefits of research and clinical reality.ObjectiveOur objective was to systematically review the factors influencing the outcome of eHealth interventions in terms of success and failure.MethodsWe searched the PubMed database for original peer-reviewed studies on implemented eHealth tools that reported on the factors for the success or failure, or both, of the intervention. We conducted the systematic review by following the patient, intervention, comparison, and outcome framework, with 2 of the authors independently reviewing the abstract and full text of the articles. We collected data using standardized forms that reflected the categorization model used in the qualitative analysis of the outcomes reported in the included articles.ResultsAmong the 903 identified articles, a total of 221 studies complied with the inclusion criteria. The studies were heterogeneous by country, type of eHealth intervention, method of implementation, and reporting perspectives. The article frequency analysis did not show a significant discrepancy between the number of reports on failure (392/844, 46.5%) and on success (452/844, 53.6%). The qualitative analysis identified 27 categories that represented the factors for success or failure of eHealth interventions. A quantitative analysis of the results revealed the category quality of healthcare (n=55) as the most mentioned as contributing to the success of eHealth interventions, and the category costs (n=42) as the most mentioned as contributing to failure. For the category with the highest unique article frequency, workflow (n=51), we conducted a full-text review. The analysis of the 23 articles that met the inclusion criteria identified 6 barriers related to workflow: workload (n=12), role definition (n=7), undermining of face-to-face communication (n=6), workflow disruption (n=6), alignment with clinical processes (n=2), and staff turnover (n=1).ConclusionsThe reviewed literature suggested that, to increase the likelihood of success of eHealth interventions, future research must ensure a positive impact in the quality of care, with particular attention given to improved diagnosis, clinical management, and patient-centered care. There is a critical need to perform in-depth studies of the workflow(s) that the intervention will support and to perceive the clinical processes involved.

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Section: Resultsmentioning

confidence: 99%

Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature

Granja¹,

Janssen²,

Johansen³

2018

J Med Internet Res

478

383

View full text Add to dashboard Cite

show abstract

“…For example, in an in-depth literature review of 225 articles focused on videoconferencing in clinics, one finding was the importance of developing protocols for using the system, which is a component of packaging the programme 19 and other studies have supported these findings. 20 Perceived usefulness of and interest in telemedicine has previously shown to increase probability of PCPs using telemedicine options. 21 Previous research has also shown the importance of reflecting and evaluating related to telehealth nursing services 22 and the challenges associated with integrating new and 'different' models of practice into deeply embedded local working structures (compatibility).…”

Section: Leadership Supportmentioning

confidence: 99%

Evaluation of a national telemedicine initiative in the Veterans Health Administration: Factors associated with successful implementation

et al. 2016

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Background The Consolidated Framework for Implementation Research was used to evaluate implementation facilitators and barriers of Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) within the Veterans Health Administration. SCAN-ECHO is a video teleconferencing-based programme where specialist teams train and mentor remotely-located primary care providers in providing routine speciality care for common chronic illnesses. The goal of SCAN-ECHO was to improve access to speciality care for Veterans. The aim of this study was to provide guidance and support for the implementation and spread of SCAN-ECHO. Methods Semi-structured telephone interviews with 55 key informants (primary care providers, specialists and support staff) were conducted post-implementation with nine sites and analysed using Consolidated Framework for Implementation Research constructs. Data were analysed to distinguish sites based on level of implementation measured by the numbers of SCAN-ECHO sessions. Surveys with all SCAN-ECHO sites further explored implementation information. Results Analysis of the interviews revealed three of 14 Consolidated Framework for Implementation Research constructs that distinguished between low and high implementation sites: design quality and packaging; compatibility; and reflecting and evaluating. The survey data generally supported these findings, while also revealing a fourth distinguishing construct - leadership engagement. All sites expressed positive attitudes toward SCAN-ECHO, despite struggling with the complexity of programme implementation. Conclusions Recommendations based on the findings include: (a) expend more effort in developing and distributing educational materials; (b) restructure the delivery process to improve programme compatibility;

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“…We implemented the current quality improvement project to provide VA specialty medical care and mental health support via telehealth to a subgroup of Eastern Colorado Health Care System (ECHCS) Veterans who reside in contracted Community Nursing Homes (CNHs). The few studies published providing elderly or nursing home care via telehealth suggest positive health outcomes, cost benefits, and staff satisfaction for patient glycemic management [8]; rehabilitation after a stroke, fall, fracture, or prolonged hospital admission [9]; continence assessment and management [10]; after hours primary care [11]; and physical therapy [12]. Evidence is also beginning to demonstrate that tele-psychiatry is a viable substitute for face-to-face visits to treat depression in elderly patients [13].…”

Section: Introductionmentioning

confidence: 99%

Vet Connect: A Quality Improvement Program to Provide Telehealth Subspecialty Care for Veterans Residing in VA-Contracted Community Nursing Homes

et al. 2018

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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.

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Telehealth Implementation in a Skilled Nursing Facility: Case Report for Physical Therapist Practice in Washington

Cited by 23 publications

References 14 publications

Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature

Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature

Evaluation of a national telemedicine initiative in the Veterans Health Administration: Factors associated with successful implementation

Vet Connect: A Quality Improvement Program to Provide Telehealth Subspecialty Care for Veterans Residing in VA-Contracted Community Nursing Homes

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