scholarly journals Development of a Home-Based Telerehabilitation Service Delivery Protocol for Wheelchair Seating and Mobility Within the Veterans Health Administration

2021 ◽  
Author(s):  
Kaila K Ott ◽  
Richard M Schein ◽  
Joseph Straatmann ◽  
Mark R Schmeler ◽  
Brad E Dicianno
Keyword(s):  
Service Delivery ◽  
Rural Areas ◽  
Healthcare Services ◽  
Lessons Learned ◽  
Veterans Health ◽  
Health Administration ◽  
Home Based ◽  
Wheeled Mobility ◽  
Delivery Protocol

ABSTRACT Introduction The provision of seating and wheeled mobility devices is a complex process that requires trained professionals and multiple appointments throughout the service delivery process. However, this can be inconvenient and burdensome for individuals with mobility limitations or for individuals who live in rural areas. Rural areas often present unique difficulties regarding the provision of healthcare services including lengthy travel times to medical facilities and lack of specialized providers and medical technology. The purpose of this article is to provide a comprehensive overview of the development and implementation of a service delivery protocol for a home-based telerehabilitation assessment for wheelchair seating and mobility. Materials and Methods The telerehabilitation team consists of a trained wheelchair seating and mobility therapist and a telehealth clinical technician (TCT). In order to determine veterans that are appropriate for a home-based telerehabilitation assessment, a three-phase pre-assessment screening process was conducted by the therapist and TCT, including consult, chart, and phone review. Veterans that met all of the predetermined eligibility criteria were recommended for a telerehabilitation wheelchair assessment. The TCT traveled to the veteran’s residence with necessary evaluation and safety equipment and connected with the therapist remotely using the VA Video Connect platform. Assessment and veteran data were collected during the initial evaluation and then during a 21-day follow-up. Results Forty-three veterans were successfully seen via telerehabilitation for a seating and wheeled mobility assessment between November, 2017 and July, 2018. The average travel distance between the veteran’s residence and the clinic was 34.1 miles. The total telerehabilitation encounter times ranged from 45 min to 145 min. Conclusions The implementation of this service delivery protocol for wheelchair seating and mobility assessments demonstrated the benefits of using telehealth services including reaching rural veterans, reducing distance traveled, maximizing efficiency of provider schedules, and conducting realistic assessments in veterans’ home environments. Success can be attributed to being able to deliver best practice remotely and to the rapport of the TCT with the providers. Cultivating provider buy-in, selecting appropriate outcome measures, and restructuring workflows were additional lessons learned. The VA Video Connect platform is an accessible tool that can be easily learned by both veterans and providers and used beyond initial wheelchair seating evaluations for improved access to follow-up healthcare services.

Assessment of patient satisfaction, financial, and environmental impacts of teleoncology.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 278-278
Author(s):  
Cindy Jiang ◽  
Garth William Strohbehn ◽  
Rachel Dedinsky ◽  
Shelby Raupp ◽  
Brittany Pannecouk ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Rural Areas ◽  
Financial Burden ◽  
Veterans Health ◽  
Health Administration ◽  
Secondary Effects ◽  
Medical Needs ◽  
Care Access ◽  
Strongly Agree

278 Background: There was rapid adoption of teleoncology at Veterans Health Administration (VHA) during the COVID-19 pandemic. One-third of 9 million VHA-enrolled Veterans live in rural areas. While digital solutions can expand capacity, enhance care access, and reduce financial burden, they may also exacerbate rural-urban health disparities. Careful evaluation of patients’ perceptions and policy tradeoffs are necessary to optimize teleoncology post-pandemic. Methods: Patients with ≥1 teleoncology visit with medical, surgical, or radiation oncology between March 2020 and June 2020 identified retrospectively. Validated, Likert-type survey assessing patient satisfaction developed. Follow-up survey conducted on patients with ≥1 teleoncology visit from August 2020 to January 2021. Travel distance, time, cost, and carbon dioxide (CO2) emissions calculated based on zip codes. Results: 100 surveys completed (response rate, 62%). Table with demographics. Patients overall satisfied with teleoncology (83% ‘Agree’ or ‘Strongly Agree’) but felt less satisfied than in-person visits (47% ‘Agree’ or ‘Strongly Agree’). Audiovisual component improved patient perception of involvement in care (two-sided, p = 0.0254), ability to self-manage health/medical needs (p = 0.0167), and comparability to in person visits (p = 0.0223). Follow-up survey demonstrated similar satisfaction. Total travel-related savings: 86,470 miles, 84,374 minutes, $49,720, and 35.5 metric tons of CO2. Conclusions: Veterans are broadly satisfied with teleoncology. Audiovisual capabilities are critical to satisfaction. This is challenging for rural populations with lack of technology access. Patients experienced financial and time savings, and society benefitted from reduced carbon emissions. Continued optimization needed to enhance patient experience and address secondary effects.[Table: see text]

Abstract P163: Racial, Gender and Regional Variation in Rates of Cardiovascular Hospitalization Among 9 Million US Veterans

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Nirupama Krishnamurthi ◽  
Mary A Whooley
Keyword(s):  
Geographical Distribution ◽  
Rural Areas ◽  
Population Level ◽  
Healthcare Services ◽  
Veterans Health ◽  
Health Administration ◽  
Health Records ◽  
Race Ethnicity ◽  
The Individual ◽  
Va Hospitals

Introduction: Little is known about population-level trends in rates of cardiovascular hospitalizations among U.S. Veterans. Recent adoption of a centralized Corporate Data Warehouse in the Veterans Health Administration (VHA) provides a new opportunity to evaluate trends in national rates of hospitalization among Veterans. We sought to determine the leading causes of cardiovascular (CV) hospitalization, and to compare national rates of CV hospitalization by age, gender, race, ethnicity, geographical distribution and year, among U.S. Veterans. Methods: We evaluated the electronic health records of all Veterans ≥18 years old that accessed VA healthcare services between January 1 2010 and December 31 2014. Among these 9,066,693 patients, we identified the 5 leading causes of CV hospitalization and compared rates of hospitalization by age, gender, race, ethnicity, geographical distribution and year. Results: The top 5 causes of CV hospitalization in VA hospitals were: chest pain (3.23 per 1,000 Veterans per year), coronary arteriosclerosis in native artery (2.36), congestive heart failure (1.82), atrial fibrillation (1.34) and acute sub-endocardial infarction (0.99). Overall, the rate of Veterans hospitalized for one or more of these CV conditions decreased over time, from 9.9 per 1000 Veterans in 2010 to 8.3 per 1000 Veterans in 2014. The odds of hospitalization due to any of the 5 conditions were higher in men vs. women (OR 1.73, p<0.0001), in urban vs. rural areas (OR 1.15, p<0.0001), and in the Southeast vs. Pacific regions (OR 1.08, p<0.0001). As compared with Whites, odds of CV hospitalization were higher in Blacks (OR 1.34, p<0.0001) but lower in Asians (OR 0.50, p<0.0001). Racial, geographic and temporal differences in rates of hospitalization were also observed for each of the individual CV conditions. Conclusions: Among U.S. Veterans enrolled in the VA healthcare system, there is substantial variation in rates of CV hospitalization by age, gender, race, geographical distribution and year.

Abstract 137: Anticoagulation clinic provider’s perspective on management of patients on target specific oral anticoagulants: insights from the Veterans Affairs Health Care System

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Supriya Shore ◽  
P. Michael Ho ◽  
Anne Lambert-Kerzner ◽  
Fran Cunningham ◽  
Madeline McCarren ◽  
...  
Keyword(s):  
Side Effects ◽  
Patient Adherence ◽  
Comparative Method ◽  
Oral Anticoagulants ◽  
Anticoagulation Clinic ◽  
Veterans Health ◽  
Health Administration ◽  
Structured Interviews ◽  
High Performing

Background: Patients on target specific anticoagulants (TSOACs) such as dabigatran do not require routine laboratory testing and dose adjustment. In the Veterans Health Administration (VHA), anticoagulation clinics (ACCs) may elect to follow and manage patients on TSOACs, but whether it is needed or the optimal duration of follow-up is unknown. Our objective was to assess the perspective of anticoagulation clinic providers on follow-up care for dabigatran patients and to identify site-level practices associated with improved adherence to dabigatran. Methods: We ascertained ACC providers’ perspectives through semi-structured interviews by a single, trained internist. Purposive sampling was utilized to recruit senior ACC providers or supervisors at VHA sites with over 20 patients on dabigatran. We stratified sites into high and low performing sites based on whether sites had ≥ 75% of their patients adherent, based on a proportion-of-days-covered calculation. Data from the interviews was analyzed by 2 reviewers in an iterative process to identify recurrent and unifying themes. Constant comparative method of qualitative data analysis was used to identify best practices across various sites. Results: We interviewed ACC providers from 39 sites - including 18 providers at 16 high-performing sites and 25 providers at 23 low-performing sites. Follow-up practices for dabigatran varied across sites, with 6 sites not providing any follow-up, 14 sites following-up patients for less than 3 months, 9 sites following-up patients for 6 months, and 10 sites following-up patients indefinitely. During these follow-up visits, patients were contacted at regular intervals, mostly via telephone, by ACC providers to provide education, assess side-effects and adherence. Key strategies implemented at high-performing sites compared to low-performing sites included (1) examining adherence to other twice daily medications prior to approving dabigatran (2) education of patients by ACC providers prior to dabigatran initiation (3) continued telephone follow up by ACC staff despite no need for INR checks. Over a third of ACC providers expressed concerns regarding patient adherence to dabigatran. Most common reasons for this concern included its special storage requirements and high incidence of gastrointestinal side effects leading to high discontinuation rates. Conclusion: Dedicated follow-up of patients on dabigatran is associated with improved adherence. A multi-disciplinary approach involving anti-coagulation clinic providers to provide education and follow-up may be beneficial in management of TSOACs. Future work should compare the apparent benefit of this strategy with its non-trivial cost.

Capacity Rationing in Primary Care: Provider Availability Shocks and Channel Diversion

2021 ◽  
Author(s):  
Hessam Bavafa ◽  
Anne Canamucio ◽  
Steven C. Marcus ◽  
Christian Terwiesch ◽  
Rachel M. Werner
Keyword(s):  
Operations Management ◽  
Care Center ◽  
Urgent Care ◽  
Veterans Health ◽  
Health Administration ◽  
Urgent Care Center ◽  
Standard Deviations ◽  
Using Data ◽  
Capacity Constrained

We study capacity rationing by servers facing differentiated customer classes using data from the Veterans Health Administration, which is the largest integrated healthcare system in the U.S. Using more than 11 million health encounters over two years in which the system was capacity constrained, our study provides a comprehensive analysis of the impacts of provider availability shocks on care channel diversion and delays. The outcomes studied include emergency room (ER) visits broken down by type, urgent care center visits, office and phone visits with one’s own versus another provider, post-ER follow-up visits, and ER readmissions. Availability shocks in our analysis are a residualized measure characterizing weeks in which the provider has fewer (or more) office appointments than expected based on typical patterns. The main finding is that moving from two standard deviations above to two standard deviations below in availability shocks increases ER visits by 2.4%, or about 20,000 yearly ER visits. Interestingly, the increase in ER visits is only present for the non-emergent category, indicating differentiated service to emergent and non-emergent care requests; capacity-constrained providers still tend to the patients in most need. Another finding is that provider availability shocks delay and divert post-ER follow-up care. Yet there is no effect on ER readmissions, a severe outcome of delayed or foregone follow-up, indicating that providers ration by priority these follow-up appointments. This paper was accepted by Vishal Gaur, operations management.

Mobilization of Moroccan Women

2019 ◽  
Vol 12 (4) ◽  
pp. 61-82
Author(s):  
Al Habib Estati Zeineldin ◽  
Saeed Chekak
Keyword(s):  
Rural Areas ◽  
Lessons Learned ◽  
Sufficient Information ◽  
Protest Movements ◽  
Sociological Approach ◽  
Women's Participation ◽  
Bibliographical Information ◽  
Moroccan Women ◽  
The Arab Spring

This article draws on the experience gained and the lessons learned during and after the Arab Spring protest movements that called for economic, social, and political change. It raises the issue of the role Moroccan women played in these movements. In attempting to address this issue, the article relies essentially on bibliographical information and data derived from studies and writings that dealt with the feminist struggle in Morocco as a whole. It suffers from the lack of openness to a sociological approach or a political viewpoint in Arab and foreign scientific productions concerned with the struggles of women in Arab or Maghreb countries. In parallel, the study uses ethnographic research discerningly, since accurate and sufficient information available on the local protest movements has not received the necessary follow-up and definition. The article first monitors the shift in the dynamics of women’s protests and focuses on the persistent manifestations within them; it also considers the motives that contribute to the growth of this dynamic while stressing the extent of women’s participation in the February 20 Movement and in rural areas. It then identifies the results and extensions of this participation in relation to the requirements of empowerment. Finally, it discusses the problem of development and democracy that prevent women from achieving the desired change in the short term.

scholarly journals Creating and disseminating a home-based cardiac rehabilitation program: experience from the Veterans Health Administration

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Bonnie J. Wakefield ◽  
Kariann Drwal ◽  
Monica Paez ◽  
Sara Grover ◽  
Carrie Franciscus ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Qualitative Data ◽  
Document Analysis ◽  
Veterans Health Administration ◽  
Rehabilitation Program ◽  
Veterans Health ◽  
High Uptake ◽  
Health Administration ◽  
Home Based ◽  
Uptake Sites

Abstract Background Cardiac rehabilitation (CR) programs provide significant benefit for people with cardiovascular disease. Despite these benefits, such services are not universally available. We designed and evaluated a national home-based CR (HBCR) program in the Veterans Health Administration (VHA). The primary aim of the study was to examine barriers and facilitators associated with site-level implementation of HBCR. Methods This study used a convergent parallel mixed-methods design with qualitative data to analyze the process of implementation, quantitative data to determine low and high uptake of the HBCR program, and the integration of the two to determine which facilitators and barriers were associated with adoption. Data were drawn from 16 VHA facilities, and included semi-structured interviews with multiple stakeholders, document analysis, and quantitative analysis of CR program attendance codes. Qualitative data were analyzed using the Consolidated Framework for Implementation Research codes including three years of document analysis and 22 interviews. Results Comparing high and low uptake programs, readiness for implementation (leadership engagement, available resources, and access to knowledge and information), planning, and engaging champions and opinion leaders were key to success. High uptake sites were more likely to seek information from the external facilitator, compared to low uptake sites. There were few adaptations to the design of the program at individual sites. Conclusion Consistent and supportive leadership, both clinical and administrative, are critical elements to getting HBCR programs up and running and sustaining programs over time. All sites in this study had external funding to develop their program, but high adopters both made better use of those resources and were able to leverage existing resources in the setting. These data will inform broader policy regarding use of HBCR services.

Assessing Readiness to Change of a High Fall Risk Patient: A Case Report

2012 ◽  
Vol 13 (1) ◽  
pp. 2-7
Author(s):  
Alexandra Lee ◽  
Julia Neily ◽  
Peter Mills ◽  
Cheryl Coutermarsh ◽  
Melissa Gates-Cantrell
Keyword(s):  
Case Report ◽  
Transtheoretical Model ◽  
Fall Risk ◽  
Readiness To Change ◽  
Risk Patient ◽  
Veterans Health ◽  
Health Administration ◽  
Home Based ◽  
Informal Interview ◽  
History Of

The case report discusses a patient with an extensive history of falls living in the community. The patient’s medical record was analyzed, and an informal interview was conducted with the patient to provide an overview of his care provided by the Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) program from June 2008 to February 2011. The report will also apply the transtheoretical model of behavioral change to discuss the behavior change process of a high fall risk patient. Applying this model to the high fall risk population may assist with decreasing the frustration of clinicians and caregivers, as it acknowledges the “smaller gains” with fall prevention.

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