1 Miami Veterans Affairs Healthcare System , Miami, Florida.
2 Miami Veterans Affairs Geriatric Research Education and Clinical Center , Miami, Florida.
Telemed J E Health. 2019 Apr;25(4):309-318. doi: 10.1089/tmj.2018.0009. Epub 2018 Jul 3.
BACKGROUND/OBJECTIVES: The Department of Veteran Affairs (VA) Home-Based Primary Care (HBPC) program provides care to over 37,000 high-risk, high-need, medically complex, and costly patients in their home. The VA's Home Telehealth (HT) program can potentially amplify HBPC's efficiency and reach, yet scarce data on use and experience with HT in HBPC exist. This exploratory study sought to provide a glimpse of HT use in HBPC and identify drivers and barriers for HT implementation.
National VA data were used to evaluate HBPC patients concurrently using HT. We conducted a cross-sectional survey of HBPC program directors to explore HT use, understand communication processes, and elicit open comments. Semistructured interviews were conducted of 18 HBPC program directors with varying HT use to clarify themes and understand HBPC experience with HT.
Fifteen percent of the overall HBPC patients used HT in 2011, with a wide variation in HT use by HBPC site. The national survey and semistructured interviews revealed that most HBPC staff recognized advantages of using HT, including increased patient engagement and staff efficiency. Crucial practices among sites with successful telehealth adoption included HT staff attending HBPC meetings and evaluating all HBPC patients for HT.
Much remains to be done for effective HT integration in HBPC. Improving communication between HT and HBPC programs and establishing a system for identifying suitable patients for HT are vital. Future studies need to delineate operational processes and gather data on the added value of HT in HBPC to guide evidence-based integration of HT in VA and Medicare HBPC programs.
背景/目的：退伍军人事务部（VA）的家庭为基础的初级保健（HBPC）计划为超过 37000 名高风险、高需求、医疗复杂和费用高昂的患者提供家庭护理。VA 的家庭远程医疗（HT）计划有可能放大 HBPC 的效率和覆盖范围，但关于 HBPC 中 HT 的使用和经验的数据很少。这项探索性研究旨在了解 HBPC 中 HT 的使用情况，并确定 HT 实施的驱动因素和障碍。
使用国家 VA 数据评估同时使用 HT 的 HBPC 患者。我们对 HBPC 项目主任进行了横断面调查，以探讨 HT 的使用情况，了解沟通流程，并征求公开意见。对 18 名具有不同 HT 使用经验的 HBPC 项目主任进行了半结构化访谈，以澄清主题并了解 HBPC 在 HT 方面的经验。
2011 年，15%的 HBPC 患者总体上使用了 HT，HBPC 站点的 HT 使用情况差异很大。全国调查和半结构化访谈显示，大多数 HBPC 工作人员认识到使用 HT 的优势，包括增加患者参与度和提高工作人员效率。成功采用远程医疗的站点的关键做法包括 HT 工作人员参加 HBPC 会议和评估所有 HBPC 患者是否适合 HT。
在 HBPC 中有效整合 HT 仍有许多工作要做。改善 HT 和 HBPC 项目之间的沟通，建立一个识别适合 HT 的患者的系统，是至关重要的。未来的研究需要详细说明操作流程，并收集 HBPC 中 HT 的附加价值的数据，以指导 VA 和 Medicare HBPC 项目中基于证据的 HT 整合。
