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2023 HSR&D/QUERI National Conference Abstract

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4022 — Evaluation of Teledermatology Programs Serving Rural Veterans Using RE-AIM Framework

Lead/Presenter: Dennis Oh,  San Francisco VAMC
All Authors: Lamkin RP (Center for Healthcare Organization and Implementation Research (CHOIR), Boston), Peracca, SB (VA San Francisco) Jackson, GL (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham; Duke University) Hines, AC (VA Detroit; Wayne State University School of Medicine) Gifford, AL (Center for Healthcare Organization and Implementation Research (CHOIR), Boston; Boston University School of Medicine) Mohr, DC (Center for Healthcare Organization and Implementation Research (CHOIR), Boston; Boston University School of Public Health) Lachica, O (VA San Francisco) Li, D (Center for Healthcare Organization and Implementation Research (CHOIR), Boston) Morris, IJ (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham) Weinstock, MA (VA Providence; Brown University; VA Office of Connected Care) Oh, DH (VA San Francisco; University of California, San Francisco Dept of Dermatology; VA Office of Connected Care)

In FY2017 VA Teledermatology Program extended its focus on rural veterans - enhancing access to dermatology services via store-and-forward teledermatology, allowing primary care providers to consult with dermatologists to diagnose and manage dermatologic conditions via digital transmission of clinical history and skin images. We evaluated progress among the second funded cohort to initiate/increase utilization of teledermatology among rural patients.

Mixed-methods evaluation of VA Rural Teledermatology Program was based on Glasgow’s RE-AIM (reach-effectiveness-adoption-implementation-maintenance) implementation evaluation framework. Funded sites completed a report covering degree of teledermatology implementation, barriers to and facilitators of teledermatology implementation, and program sustainability/maintenance for FY2021. Utilization data was derived from VA administrative data.

Reach. 13,229 teledermatology encounters among 10,146 unique patients at 6 funded reading sites and their 61 referral clinic locations in FY2021. Between FY2020 and FY2021, the number of rural patients with teledermatology encounters at funded sites increased by 86%. Effectiveness. Relative to sites that did not receive funding, funded sites served Veterans who lived farther from face-to-face services (23 miles vs. 20 miles). Adoption. Slightly over half of the 61 referral sites (57%) were in a rural area. Implementation. Teledermatology constituted 13.6% of dermatology visits at funded sites compared with 10.2% nationally. Funded sites engaged in a variety of strategies to enhance implementation of teledermatology, including outreach to veterans. Maintenance. A modification of Stages of Implementation Completion and Program Sustainability Index were used to document implementation milestones and program maintenance factors. All sites were either fully implementing, moving toward fully implementing or were ready to expand. The greatest maintenance uncertainties related to the availability of future funding as well as the ability of the program to adapt to changing Veteran needs.

An overall high degree of implementation and sustainability of teledermatology was reflected in the successes of grantees and large number of patients served. Grant funds were used to help address key challenges such as staffing. Ongoing efforts are needed to enhance collaboration between primary care and dermatology.

Asynchronous telehealth programs contribute to our goal of extending dermatology access nationwide. Providing program guidance and staffing and training resources can increase the impact of these programs, with efforts aimed at enhancing primary care specialty collaboration.