BACKGROUND/RATIONALE:
VHA is a national leader in using distance technology to monitor patients' self-care via an in-home messaging device with disease management protocols (DMPs). No such DMPs exist for the community dwelling spinal cord injury/disorders (SCI/D) population. Our objective is to develop the tools necessary for implementing a new home telehealth program to manage community-dwelling veterans with SCI/D at high risk of developing pressure ulcers (PrUs).

OBJECTIVE(S):
The goal of the study was to complete activities necessary in preparation for implementing a Home Telehealth program to manage veterans with SCI/D at risk of developing PrUs. Specifically this RRP included: 1) Convening an expert panel to validate PrU DMP items; 2) Developing a standardized protocol that specified how the nurse Care Coordinator who would manage patients who develop open skin wounds across the Hub and Spoke system of care; 3) Assessing individual telehealth DMP items by calling a sample of patients on a daily or weekly basis for up to 2 months to determine their validity and 4) Developing an instrument to assess staff satisfaction with this method of patient management.

METHODS:
A convenience sample of veterans about to be discharged home from the Cleveland SCI/D inpatient unit were asked to participate in the study. This included patients living close to the Hub and those referred from spoke sites. Subjects were randomly assigned to receive either daily calls (5 days/week) for 40 total calls, or weekly calls (8 total calls) over the course of the 8 week/2month study intervention period.

FINDINGS/RESULTS:
18 patients were enrolled in the study with 10 receiving calls on a daily basis and 8 receiving weekly calls. The DMP was more successfully administered for the weekly group with more patients completing all study calls. However, the daily group reported fewer issues during these calls. This study appears to support many others that have found that education (knowledge) is necessary but not sufficient to prevent skin breakdown. Even though patients scored high on baseline knowledge, they did report that they liked having the frequent feedback as a way to help motivate them to change their behaviors. It appears that patients are interested and engaged in outpatient interventions such as this may facilitate patients' ability to better manage their skin at home. Thus, future research might include the DMP as part of a multi-faceted intervention to address the myriad of risk factors for PrUs that patients with SCI face.

IMPACT:
This study will address patient self-management, prevention, access to care, and early detection/ intervention. Further, this evaluation of home telehealth to help patients manage/prevent skin breakdown will be used to help SCI QUERI better understand issues associated with future implementation of this type of program in other VA SCI Hub-and-Spoke sites. These are necessary steps for a larger study to implement and assess the use of home telehealth data messaging units as a method for helping SCI/D patients prevent development of PrUs.

---

External Links for this Project

---

PUBLICATIONS:

Journal Articles

1. Woo C, Guihan M, Frick C, Gill CM, Ho CH. What's happening now! Telehealth management of spinal cord injury/disorders. The journal of spinal cord medicine. 2011 Jan 1; 34(3):322-31. [view]

Conference Presentations

1. Guihan M, Ho C, Woo C. Developing a Home Telehealth Program to Manage Pressure Ulcers in Spinal Cord Injury/Disorder. Poster session presented at: VA Care Coordination and Telehealth Leadership Annual Forum; 2008 Jun 4; Minneapolis, MN. [view]
2. Guihan ML, Ho CH, Lowery JC, Gillon L, Reiber GE, Raugi GJ. Improving Wound Care Access and Coordination Between Home and VA Primary and Tertiary Care Medical Centers. Presented at: VA QUERI National Meeting; 2008 Dec 11; Phoenix, AZ. [view]
3. Young K, Ho C, Guihan M, Woo C. Spinal Cord Injury Telehealth Initiatives and Applications: Part I. Poster session presented at: Spinal Cord Medicine and Rehabilitation Annual Congress; 2008 Aug 10; Orlando, FL. [view]
4. Guihan M, Ho C, Woo C. Spinal Cord Injury Telehealth Initiatives and Applications: Part II. Poster session presented at: Spinal Cord Medicine and Rehabilitation Annual Congress; 2008 Aug 12; Orlando, FL. [view]
5. Woo C, Guihan M, Ho C. Spinal Cord Injury Telehealth Initiatives and Applications: Part III. Poster session presented at: Spinal Cord Medicine and Rehabilitation Annual Congress; 2008 Aug 10; Orlando, FL. [view]

DRA: none
DRE: none
Keywords: Spinal cord injury, Telemedicine
MeSH Terms: none