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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

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National Meeting 2008

3042 — Use of Telehealth in VHA for Chronic Disease Management and Depression Care

Chumbler NR (REAP - Gainesville), Doebbeling BN (COE - Indianapolis), Yano EM (COE - Sepulveda)

Objectives:
VHA’s Office of Care Coordination (OCC) developed and implemented a system-wide patient-centric Care Coordination/Home-Telehealth CCHT program in all 21 VISNs in 2005. OCC uses telehealth technologies (e.g., messaging devices) to coordinate care directly from a veteran’s home to help self-manage their disabling chronic diseases (e.g., congestive heart failure; diabetes) and mental illnesses (e.g., depression). Goals include improved health status, reducing hospitalizations and averting unnecessary outpatient visits. Despite over 28,000 veterans enrolled in the CCHT program to date, there is substantial variability in the enrolled cohorts both across and within VISNs. The goals of this project were to provide nationally representative data on the use of telehealth in VA Medical Centers (VAMCs).

Methods:
The VA Clinical Practice Organizational Survey (CPOS) Study, funded by VA’s Office of Quality & Performance and VA HSR&D, was administered to Chief of Staffs at each VAMC. The survey was designed to meet operational needs by measuring the organizational and practice system features of care at individual VAMCs that may be associated with VA performance.

Results:
111 VA COS participated (86%). Most VAMCs used telehealth (e.g., messaging devices to communicate symptoms) for patients with congestive heart failure (CHF, 82%), diabetes mellitus (DM, 78%) and hypertension (72%). Telehealth was infrequently used to provide depression care (33%), or weight management (26%) care. Telemedicine (e.g. linking CBOC patients to VA providers) was used frequently for depression (62%), but infrequently for eye exams (35%), CHF (17%), weight management (14%), and DM other than eye exams (13%).

Implications:
Many VAMCs have implemented telehealth to monitor symptoms for costly chronic diseases, such as CHF, DM and hypertension. Telehealth is infrequently used to deliver depression and weight management care in VHA. Telemedicine to link CBOC patients to providers is used most for depression and eye exams.

Impacts:
Despite the rapid and aggressive implementation of telehealth technologies to monitor disabling chronic diseases, considerable variability exists, especially in depression care and the use of telemedicine to link patients to providers. Further investigation of the structural variations in care and their links to quality could provide insights to inform the design of more telehealth implementation efforts.


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