scholarly journals Implementing a Telehospitalist Program Between Veterans Health Administration Hospitals: Outcomes, Acceptance, and Barriers to Implementation

2021 ◽  
Vol 16 (3) ◽  
pp. 156-163
Author(s):  
Jeydith Gutierrez ◽  
Jane Moeckli, ◽  
Andrea Holcombe ◽  
Amy MJ O’Shea ◽  
George Bailey ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Program Implementation ◽  
Readmission Rate ◽  
Low Complexity ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Structured Interviews ◽  
Improvement Program ◽  
Process Measures

BACKGROUND: Telehospitalist services are an innovative alternative approach to address staffing issues in rural and small hospitals. OBJECTIVE: To determine clinical outcomes and staff and patient satisfaction with a novel telehospitalist program among Veterans Health Administration (VHA) hospitals. DESIGN, SETTING, AND PARTICIPANTS: We conducted a mixed-methods evaluation of a quality improvement program with pre- and postimplementation measures. The hub site was a tertiary (high-complexity) VHA hospital, and the spoke site was a 10-bed inpatient medical unit at a rural (low-complexity) VHA hospital. All patients admitted during the study period were assigned to the spoke site. INTERVENTION: Real-time videoconferencing was used to connect a remote hospitalist physician with an on-site advanced practice provider and patients. Encounters were documented in the electronic health record. MAIN OUTCOMES: Process measures included workload, patient encounters, and daily census. Outcome measures included length of stay (LOS), readmission rate, mortality, and satisfaction of providers, staff, and patients. Surveys measured satisfaction. Qualitative analysis included unstructured and semi-structured interviews with spoke-site staff. RESULTS: Telehospitalist program implementation led to a significant reduction in LOS (3.0 [SD, 0.7] days vs 2.3 [SD, 0.3] days). The readmission rate was slightly higher in the telehospitalist group, with no change in mortality rate. Satisfaction among teleproviders was very high. Hub staff perceived the service as valuable, though satisfaction with the program was mixed. Technology and communication challenges were identified, but patient satisfaction remained mostly unchanged. CONCLUSION: Telehospitalist programs are a feasible and safe way to provide inpatient coverage and address rural hospital staffing needs. Ensuring adequate technological quality and addressing staff concerns in a timely manner can enhance program performance.

Iraq and Afghanistan Veterans’ Use of Veterans Health Administration and Purchased Care Before and After Veterans Choice Program Implementation

Medical Care ◽  
2017 ◽  
Vol 55 ◽  
pp. S37-S44 ◽  
Author(s):  
Megan E. Vanneman ◽  
Alex H.S. Harris ◽  
Steven M. Asch ◽  
Winifred J. Scott ◽  
Samantha S. Murrell ◽  
...  
Keyword(s):  
Program Implementation ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Before And After ◽  
Choice Program

scholarly journals Implementing Internet-Based Self-Care Programs in Primary Care: Qualitative Analysis of Determinants of Practice for Patients and Providers

2018 ◽  
Vol 5 (2) ◽  
pp. e42 ◽  
Author(s):  
Eric Hermes ◽  
Laura Burrone ◽  
Elliottnell Perez ◽  
Steve Martino ◽  
Michael Rowe
Keyword(s):  
Primary Care ◽  
Qualitative Analysis ◽  
Program Implementation ◽  
Self Care ◽  
Care Program ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Human Contact ◽  
Determinants Of Practice

Background Access to evidence-based interventions for common mental health conditions is limited due to geographic distance, scheduling, stigma, and provider availability. Internet-based self-care programs may mitigate these barriers. However, little is known about internet-based self-care program implementation in US health care systems. Objective The objective of this study was to identify determinants of practice for internet-based self-care program use in primary care by eliciting provider and administrator perspectives on internet-based self-care program implementation. Methods The objective was explored through qualitative analysis of semistructured interviews with primary care providers and administrators from the Veterans Health Administration. Participants were identified using a reputation-based snowball design. Interviews focused on identifying determinants of practice for the use of internet-based self-care programs at the point of care in Veterans Health Administration primary care. Qualitative analysis of transcripts was performed using thematic coding. Results A total of 20 physicians, psychologists, social workers, and nurses participated in interviews. Among this group, internet-based self-care program use was relatively low, but support for the platform was assessed as relatively high. Themes were organized into determinants active at patient and provider levels. Perceived patient-level determinants included literacy, age, internet access, patient expectations, internet-based self-care program fit with patient experiences, interest and motivation, and face-to-face human contact. Perceived provider-level determinants included familiarity with internet-based self-care programs, changes to traditional care delivery, face-to-face human contact, competing demands, and age. Conclusions This exploration of perspectives on internet-based self-care program implementation among Veterans Health Administration providers and administrators revealed key determinants of practice, which can be used to develop comprehensive strategies for the implementation of internet-based self-care programs in primary care settings.

Teleoncology for Veterans: High Patient Satisfaction Coupled With Positive Financial and Environmental Impacts

2021 ◽  
pp. OP.21.00317
Author(s):  
Cindy Y. Jiang ◽  
Garth W. Strohbehn ◽  
Rachel M. Dedinsky ◽  
Shelby M. Raupp ◽  
Brittany M. Pannecouk ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Patient Satisfaction ◽  
Carbon Dioxide Emissions ◽  
Financial Burden ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Medical Needs ◽  
Strongly Agree

PURPOSE: There was rapid adoption of teleoncology care in the Veterans Health Administration during the COVID-19 pandemic. One third of 9 million Veterans Health Administration enrolled Veterans live in rural areas. Although 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 postpandemic. METHODS: Patients with ≥ 1 teleoncology visit with medical, surgical, or radiation oncology between March 2020 and June 2020 were identified retrospectively. Validated, Likert-type survey assessing patient satisfaction was developed. Follow-up survey was conducted on patients with ≥ 1 teleoncology visit from August 2020 to January 2021. Travel distance, time, cost, and carbon dioxide emissions were calculated based on zip codes. RESULTS: A hundred surveys were completed (response rate, 62%). Patients overall were 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, ability to self-manage health or medical needs, and comparability to in-person visits. Follow-up survey demonstrated similar satisfaction. Total travel-related savings are as follows: 86,470 miles, 84,374 minutes, $49,720 US dollars, and 35.5 metric tons of carbon dioxide. CONCLUSION: 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 is needed to enhance patient experience and address secondary effects.

scholarly journals Implementing Internet-Based Self-Care Programs in Primary Care: Qualitative Analysis of Determinants of Practice for Patients and Providers (Preprint)

2017 ◽  
Author(s):  
Eric Hermes ◽  
Laura Burrone ◽  
Elliottnell Perez ◽  
Steve Martino ◽  
Michael Rowe
Keyword(s):  
Primary Care ◽  
Qualitative Analysis ◽  
Program Implementation ◽  
Self Care ◽  
Care Program ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Human Contact ◽  
Determinants Of Practice

BACKGROUND Access to evidence-based interventions for common mental health conditions is limited due to geographic distance, scheduling, stigma, and provider availability. Internet-based self-care programs may mitigate these barriers. However, little is known about internet-based self-care program implementation in US health care systems. OBJECTIVE The objective of this study was to identify determinants of practice for internet-based self-care program use in primary care by eliciting provider and administrator perspectives on internet-based self-care program implementation. METHODS The objective was explored through qualitative analysis of semistructured interviews with primary care providers and administrators from the Veterans Health Administration. Participants were identified using a reputation-based snowball design. Interviews focused on identifying determinants of practice for the use of internet-based self-care programs at the point of care in Veterans Health Administration primary care. Qualitative analysis of transcripts was performed using thematic coding. RESULTS A total of 20 physicians, psychologists, social workers, and nurses participated in interviews. Among this group, internet-based self-care program use was relatively low, but support for the platform was assessed as relatively high. Themes were organized into determinants active at patient and provider levels. Perceived patient-level determinants included literacy, age, internet access, patient expectations, internet-based self-care program fit with patient experiences, interest and motivation, and face-to-face human contact. Perceived provider-level determinants included familiarity with internet-based self-care programs, changes to traditional care delivery, face-to-face human contact, competing demands, and age. CONCLUSIONS This exploration of perspectives on internet-based self-care program implementation among Veterans Health Administration providers and administrators revealed key determinants of practice, which can be used to develop comprehensive strategies for the implementation of internet-based self-care programs in primary care settings.

scholarly journals Patient satisfaction of female and male users of veterans health administration services

2006 ◽  
Vol 21 (S3) ◽  
pp. S26-S32 ◽  
Author(s):  
Steven M. Wright ◽  
Thomas Craig ◽  
Stacey Campbell ◽  
Jim Schaefer ◽  
Charles Humble
Keyword(s):  
Patient Satisfaction ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration

scholarly journals Rapid Versus Traditional Qualitative Analysis Using the Consolidated Framework for Implementation Research (CFIR)

2020 ◽  
Author(s):  
Andrea Nevedal ◽  
Caitlin Reardon ◽  
Marilla Opra Widerquist ◽  
George Jackson ◽  
Sarah Cutrona ◽  
...  
Keyword(s):  
Implementation Research ◽  
Veterans Health Administration ◽  
Rapid Analysis ◽  
Analysis Approach ◽  
Veterans Health ◽  
Health Administration ◽  
Structured Interviews ◽  
Qualitative Approaches ◽  
Data Collection And Analysis ◽  
Audio Recordings

Abstract BackgroundQualitative approaches, alone or in mixed methods, are prominent within implementation science. However, traditional qualitative approaches are resource intensive, which has led to the development of rapid qualitative approaches. Published rapid approaches are often inductive in nature and rely on transcripts of interviews; we describe a deductive rapid approach using the Consolidated Framework for Implementation Research (CFIR) that relies on notes and audio recordings. This paper compares our rapid approach to a traditional qualitative approach. MethodsSemi-structured interviews were conducted for two cohorts of the Veterans Health Administration (VHA) Diffusion of Excellence (DoE). The CFIR guided data collection and analysis. In Cohort A, we used a traditional analysis approach, where two analysts completed line-by-line independent coding of interview transcripts. In Cohort B, we used a rapid analysis approach, where the primary analyst wrote detailed notes during interviews and immediately “coded” them into a MS Excel CFIR construct by facility matrix; a secondary analyst then listened to audio recordings and edited notes. We tracked time for the traditional and rapid approaches using a spreadsheet and captured transcription costs from invoices. We retrospectively compared approaches in terms of effectiveness and rigor. ResultsCohort A and B were relatively equivalent in terms of data collected. However, the rapid approach required significantly fewer analyst hours and eliminated $7,250 in transcription costs. Despite these differences, both approaches were effective in meeting our evaluation objectives and establishing rigor. ConclusionOur rapid approach was less time intensive and eliminated transcription costs, yet effective in meeting evaluation objectives and establishing rigor.

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