This study would provide pilot data on feasibility and acceptability of telemedicine in postoperative cardiac surgical patients. The use of telemedicine in surgical patients has the potential of providing a more cost- effective health care delivery in the Veterans Health Administration (VHA). Once feasibility and acceptability of telemedicine in cardiac surgical patients are established, a subsequent larger randomized controlled trial will be designed to assess the cost-effectiveness of telemedicine in surgery in order to reduce unnecessary treatment costs in the VHA. The expected result of this pilot study would provide proof of concept and facilitate the use of telemedicine in cardiac surgical patients in an effort to ultimately improve the process of health care delivery in VHA. Less than one third of VHA medical centers have the resources to perform cardiac surgery. For this reason, most veterans in need of cardiac surgical procedures travel great distances to one of 44 VHA cardiac surgery centers in order to be evaluated by a cardiac surgeon. After the discharge, patients who underwent cardiac surgery need to receive a follow-up evaluation by the cardiac surgeons. In most situations, the postoperative evaluation is finished in less than 30 minutes by a cardiac surgeon without additional medical interventions. The inconvenience and cost of seeing a surgeon from an outside referral includes travel and lodging for the patient and his/her family members during the preoperatively and postoperatively visits. The use of telemedicine via video conferencing (VC) has the potential of reducing the cost of unnecessary travels and lodging by assessing the patient's preoperative and postoperative performance/physiologic status via live video feeds prior to making decisions on whether or not a face-to-face consultation is necessary. The goal of this pilot study is to examine the feasibility and acceptability of telemedicine in the form of VC during a virtual visit in comparison with the traditional face-to-face interaction between surgeons and patients after cardiac surgery.
The specific aims are: 1)To determine the feasibility for delivering telemedicine in the form of VC to cardiac surgical patients after discharge; 2)To determine the acceptability of patients and surgeons to use telemedicine in cardiac surgery; 3)To test the feasibility of recruiting eligible patients who underwent cardiac surgery in the study; 4)To collect pilot data on cost of virtual visits with VC and the traditional face-to-face visits. The proposed pilot study is a prospective cohort study. Quantitative and qualitative approaches will be used in this study. To address specific aim 1), we will collect data using a standardized clinic template in 2 interactive settings: virtual visit with VC and traditional face-to-face visit. The clinic template will be used to determine the diagnostic and therapeutic concordance between virtual visits and face-to-face visits. To address specific aim 2), a validated 17-item questionnaire will be given to subjects and physicians during the virtual visit. This would be used as an instrument to quantify the degree of acceptability of telemedicine by patients and physicians.
Specific aims 3) and 4) will be addressed by collecting quantitative data on recruitment rate and cost of both virtual and face-to-face visits for the purpose of designing a subsequent larger efficacy trial.
The proposed pilot project will assess the accuracy, acceptability, and feasibility of hospital- based telemedicine for the delivery of postoperative care for cardiac surgical patients. Since only a minority of Veterans Affairs (VA) medical centers perform cardiac surgery, most patients travel great distances to obtain cardiac surgical care. Therefore, the VA represents a unique setting for this pilot study. A majority of these patients are seen once in the cardiac surgery postoperative clinic and discharged to primary care physician's care. The expected result of this study will improve patient satisfaction and access due to the increased convenience of using telemedicine at a remote setting. This study will also benefit the Veterans Health Administration (VHA) by providing the proof of concept for a more cost-effective postoperative cardiac surgical care using telemedicine by decreasing the unnecessary costs of travel and lodging.
