Miami Veterans Affairs Geriatric Research Education and Clinical Center, Miami, Florida.
Miami Veterans Affairs Healthcare System, Miami, Florida.
J Am Geriatr Soc. 2019 Sep;67(9):1928-1933. doi: 10.1111/jgs.16045. Epub 2019 Jul 25.
To describe the structural characteristics and challenges associated with home telehealth (HT) use in the US Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program.
We designed a national survey to collect information about HBPC program structural characteristics. The survey included eight organizational and service domains, one of which was HT. HBPC program directors were surveyed online using REDCap.
We received 232 surveys from 394 HBPC sites (59% response rate).
HBPC structural domains were compared between sites using and not using HT technology. Open-ended responses were analyzed using content analysis.
A total of 127 sites (76%) used HT, which was more likely when HBPC sites were aligned organizationally with the VA's Geriatrics and Extended Care Services division, when there were more disciplines on the HBPC team, and when primary care providers made home visits. Program directors overwhelmingly viewed HT as contributing to managing veterans' complex chronic conditions (81%), yet HT data were not readily integrated into care planning (24%). Challenges to HT use included veterans' acceptance and adherence, device issues, and collaboration between HBPC teams and HT staff.
Corresponding to HBPC's complexity, HT use is primarily a self-organizing process that shapes the patterns of integration at each site. Although HT technology is compatible with core structures of the HBPC model, usability varies, and overall is low. To optimize HT use in HBPC, there are opportunities to redesign systems to mitigate challenges to adoption. As the Centers for Medicare and Medicaid Services' strives to increase access to both HBPC and telehealth benefits, evidenced by the continuation of its successful Independence at Home demonstration and the final changes in the proposed rule in April 2019 incorporating additional telehealth benefits for beneficiaries, this information will be relevant to VA and non-VA alike. J Am Geriatr Soc 67:1928-1933, 2019.
描述美国退伍军人事务部（VA）家庭为基础的初级保健（HBPC）计划中家庭远程医疗（HT）使用的结构特征和相关挑战。
我们设计了一项全国性调查，以收集 HBPC 计划结构特征的信息。该调查包括八个组织和服务领域，其中之一是 HT。使用 REDCap 对 HBPC 项目主任进行在线调查。
我们从 394 个 HBPC 站点收到了 232 份调查（59%的回复率）。
使用和不使用 HT 技术的 HBPC 结构域在站点之间进行了比较。使用内容分析对开放式回答进行了分析。
共有 127 个站点（76%）使用 HT，当 HBPC 站点与 VA 的老年病学和扩展护理服务部门组织上一致时，当 HBPC 团队中有更多的学科时，当初级保健提供者进行家访时，使用 HT 的可能性更大。项目主任普遍认为 HT 有助于管理退伍军人的复杂慢性病（81%），但 HT 数据不易整合到护理计划中（24%）。HT 使用的挑战包括退伍军人的接受和坚持、设备问题以及 HBPC 团队与 HT 工作人员之间的合作。
与 HBPC 的复杂性相对应，HT 使用主要是一个自我组织的过程，它塑造了每个站点整合的模式。尽管 HT 技术与 HBPC 模型的核心结构兼容，但可用性不同，总体水平较低。为了优化 HBPC 中的 HT 使用，有机会重新设计系统以减轻采用的挑战。随着医疗保险和医疗补助服务中心（CMS）努力增加 HBPC 和远程医疗福利的获取，这一点通过其成功的 Independence at Home 演示的延续以及 2019 年 4 月最终修改的提议规则得到体现，该规则纳入了受益人更多的远程医疗福利，这一信息对 VA 和非 VA 都是相关的。J Am Geriatr Soc 67:1928-1933, 2019.
