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Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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2005 — Technology Implementation to Increase Rural Veterans' Access to Services

Lead/Presenter: Teresa Damush, COIN - Indianapolis
All Authors: Damush TM T ( PRISM QUERI; HSRD CHIC COIN Indianapolis) Graham G G (VHA Office of Neurology; TeleStroke Executive Sponsor) Moeckli J J (Iowa City, IA VAMC) Williams LS LS (PRISM QUERI; HSRD CHIC COIN Indianapolis)

Brief description of panelists:
Tom Klobucar, Ph.D., Acting Director, Office of Rural Health Services Glenn Graham, MD PhD, Deputy Director of Neurology, Specialty Care Services, TeleStroke Executive Sponsor Linda Williams, MD, PRIS-M QUERI Director and TeleStroke Evaluator Jane Moeckli, Ph.D., HSRD, Iowa City VAMC, TeleICU Evaluator Bonnie Wakefield, RN, Ph.D., Virtual Specialty Care QUERI, Clinical Video Telehealth in Home-based Cardiac Rehabilitation Moderator: Teresa Damush, Ph.D., PRIS-M QUERI Implementation Scientist

Description of the question or issue that will be discussed:
VHA Operational Partners are interested in using new technologies to extend facility services and bring access to timely, evidence based VHA care to Veterans living in rural areas. Numerous issues may impact implementation and evaluation of this type of intervention. This session will discuss key factors to consider in developing, implementing, and sustaining a successful telehealth-focused partnership. The Office of Rural Health Services will discuss from a partner perspective what key factors they seek in an evaluation partner. The TeleStroke Executive will discuss the challenges in establishing and implementing the technological intervention pieces across the facilities within the National Healthcare System and integrating virtual specialty care services with local acute care in rural VAMC facilities. For the evaluation, the appropriateness, timeliness, and quality of care are paramount. Prospective implementation, documentation, and evaluation are difficult to capture in an evolving clinical project without burdening the users. Veteran and staff acceptance of change, attitudes to new technologies, and overall satisfaction are important considerations. Finally, for the implementation strategy of audit and feedback, a service team with a mix of local and remote members may experience challenges in evaluating and reflecting on their performance data.

Significance—Description of why the issue is important for Veterans, VA, and the audience:
The application of technology for acute and therapeutic care services across a healthcare system is challenging to coordinate to ensure daily access, compliance with policies, and trouble shooting. Personnel allocation is important because there is often a shortage of clinicians with specialty care expertise. Planning for prospective data collection and implementation tracking are key issues in order to evaluate factors contributing to implementation success. The integration into the usual work flow of the organization, acceptance by existing staff, and the quality of that remote exchange are important evaluation domains.