Background. Access to care is a high priority for VA, especially for Veterans living in rural or highly rural areas needing specialized care. Care of wounds such as diabetic foot ulcers is complex, costly, and can result in significant adverse events including hospitalization, amputation, and even death. TeleWound Practice, an effort to improve access for rural Veterans needing specialized wound care, was selected by the VA Under Secretary for Health and the Diffusion of Excellence (DOE) Office's Shark Tank competition as a Gold Star Practice to be implemented nationally, beginning in VISN 15. In partnership with DOE, Office of Nursing Services (ONS), and Office of Connected Care ? Telehealth Services (OCC-TS), we propose the TeleWound Practice Partnered Evaluation Initiative to evaluate the implementation and impacts of the TeleWound Practice.
Specific Aims. The aims of the TeleWound Practice PEI are to: (1) Evaluate the implementation of the TeleWound Practice by examining stakeholder perspectives of facilitators and barriers, assessing patient and provider satisfaction, observing processes and workflow, and testing reach of the program by number of patients using TeleWound Practice for wound care, (2) Assess the impact of the TeleWound Practice on clinical outcomes related to wound care, and (3) Assess the impact of the TeleWound Practice on healthcare system outcomes related to wound care. Significance. Using technology to support access to care, to promote patient engagement, and to embrace the individual needs and preferences of Veterans is directly reflected in VA's 2018-2024 Strategic Plan current priorities to (1) ensure greater choices and enhanced access, (2) improve timeliness of care, and (3) modernize VA systems, including health information technology. Innovation. A key component of the VA Maintaining Systems & Strengthening Integrated Outside Networks (MISSION) Act is the use of virtual care to improve access and quality of care, which is particularly important as over 37% of Veterans receiving care through VA reside in rural and highly rural areas. VA's transformation to a Learning Healthcare System involves aligning science with clinical priorities to conduct more rapid and efficient studies that evaluate the effectiveness and/or implementation of new programs (e.g., TeleWound Practice) or policies that address the priorities of VA leadership. The significance of the current work is also reflected in the mission of the VA to facilitate the development of results-driven innovations to improve quality, access, and transparency of care for Veterans. Methods. We propose a mixed-methods assessment.
We aim to understand stakeholder perspectives regarding barriers and facilitators that influence successful implementation of the TeleWound Practice across VISN 15 medical centers and VA outpatient clinics using surveys and semi-structured interviews (Aim 1). Stakeholders include facility leadership, healthcare team members (i.e., clinic managers, telehealth staff, and wound care specialists), and Veterans. We will conduct site visits at two VISN 15 Medical Centers and four rural Outpatient Clinics to observe the processes and work flow involved in conducting wound care visits over Telehealth technologies and speak with those involved in the TeleWound Practice. Using data from national databases, we will test the impact of the TeleWound Practice on numbers of patients receiving wound care over telehealth technologies (Aim 1), clinical outcomes (Aim 2), and healthcare system outcomes (Aim 3). Expected Results. As the goal is to implement TeleWound Practice across VISN 15 over the next year, considering how best to build capacity through a refined and enhanced implementation strategy will be a main goal of our work as soon as the PEI is launched. Next Step(s). Our collaborations with key partners on the TeleWound Practice PEI will help fill the gap regarding evidence for future implementation strategies to enhance telehealth use for wound care delivery.
TeleWound Practice, an effort to improve access for rural Veterans needing specialized wound care, was selected by the VA Under Secretary for Health and the Diffusion of Excellence (DOE) Office's Shark Tank competition as a Gold Star Practice to be implemented nationally. In partnership with DOE, Office of Nursing Services, and Office of Connected Care ? Telehealth Services, the TeleWound Practice Partnered Evaluation Initiative aims to evaluate the implementation and impacts of the TeleWound Practice. As the goal is to implement TeleWound Practice across VISN 15 over the next year, considering how best to build capacity through a refined and enhanced implementation strategy will be a main goal of our work as soon as the PEI is launched. Our collaborations with key partners on the TeleWound Practice PEI will help fill the gap regarding evidence for future implementation strategies to enhance telehealth use for wound care delivery.
