THE IMPLEMENTATION OF CARE COORDINATION AND HOME TELEHEALTH

In this time of war there exists a heightened awareness of doing more with less, and the Veterans Administration (VA) has transformed itself and taken the lead in delivering value-added healthcare utilizing technology solutions in ways that promote patient

THE IMPLEMENTATION OF CARE COORDINATION AND HOME TELEHEALTH PROGRAMS IN THE VA MID-ATLANTIC

HEALTHCARE NETWORK (VISN 6):

A RESEARCH PROPOSAL

Dorothea LaChon Abraham

College of William and Mary

Chon.Abraham@business.wm.edu

David Rosenthal

East Carolina University

rosenthald@mail.ecu.edu

Abstract

In this time of war there exists a heightened awareness of doing more with less, and the Veterans Administration (VA) has transformed itself and taken the lead in delivering value-added healthcare utilizing technology solutions in ways that promote patient empowerment, build relationships with providers and ultimately improve clinical care outcomes through telemedicine initiatives. The research proposed here is in the form of a longitudinal case study (i.e., research duration spanning pre and post implementation) examining the home telehealth care project as directed by a northeast VA medical facility that seeks to do the following: (1) during pre and post implementation, chronicle the socio-technical aspects (e.g., degree of task-technology fit, healthcare provider expectations and satisfaction, training, and resistance to change issues), (2) during post implementation, provide empirical analysis for the relationship between use of technologies facilitating home telehealth care for eligible veterans, healthcare provider productivity, cost of service, and patient satisfaction.

Keywords: telemedicine, home care, telehealth technology, Veterans Administration (VA)

Introduction

The quality of healthcare provided in this country is steadily increasing thanks in part to technological innovations that empower patients and their practitioners in ways that are not only effective, but appear to be grounded in sensibility and efficiency. However, with the average life expectancy now estimated to be approximately 77.2 years (Center for Disease Control and Prevention, 2001), disease prevention and treatment of an ever-increasing geriatric population has become a major agent for change, forcing the healthcare industry to rethink many of its traditional paradigms. Compared to its civilian counterparts, the Veterans Healthcare Administration (VHA), and its many VA hospitals and clinics across this country are openly embracing this paradigm shift.

Robert Roswell, Under Secretary for Health in the Department of Veterans Affairs credits the transformation of the delivery of veteran’s healthcare to four major areas of improvement (Roswell, 2003):

Cost - delivery of care to America’s veterans has shifted from inpatient to outpatient, resulting in a 24 percent decrease in the cost of care per veteran.

In this time of war there exists a heightened awareness of doing more with less, and the Veterans Administration (VA) has transformed itself and taken the lead in delivering value-added healthcare utilizing technology solutions in ways that promote patient

Access - The role of the VA has changed from a provider of catastrophic, last resort healthcare, to that of primary care provider for all veterans enrolled in the VA system. Quality - VA outcomes have exceeded best-reported performance in 16 of 18 healthcare quality indicators, as compared to data from managed care organizations, population-based surveys, and government sources. Patient Satisfaction – VA customer satisfaction index scores for pharmacy and inpatient care services have

consistently been in the “high” range as measured on the American Customer Satisfaction Index, a cross-

industry/government survey of customer satisfaction, used since 1995 to measure how well the veterans’

experiences matched their expectations during their last visit to a VA medical center.

Roswell (2003) has also identified three factors as contributing significantly to this transformation:

The reorganization of the VHA from a Medical Center focus to that of a Veterans Integrated Service Network (VISN), the shifting of the management emphasis from single medical centers to a collaborative cluster of regional medical centers, and the VHA’s excellent information technology platform, which is at the heart of the changes in VA healthcare.

Many of the new healthcare initiatives being put into place by the VA are overseen by the Office of Care Coordination

(OCC), which was established in July of 2003 and tasked with creating ways in which technology can be incorporated within the coordination of healthcare services in VISNs to ensure that veterans receive “…the right care at the right place at the right time” (Spotswood, 2004). The OCC emerged out of the need to implement a wider use of new technologies in telehealth such as telemonitors, in-home messaging devices and personal computers, to empower patients, facilitate convenience and improve patient satisfaction (Spotswood).

The VA program that has successfully incorporated telehealth technologies into care coordination programs is the Care

Coordination/Home Telehealth (CCHT) project, piloted in Florida’s VISN 8 Sunshine Healthcare Network in 2000. The aim of the VISN 8 CCHT project was to use technology to treat and maintain in their homes, veteran patients who suffer from chronic diseases (Spotswood, 2004; Office of Care Coordination, n.d.; Meyer, Cobb, & Ryan, 2002). 2002 outcomes

analysis for the Florida CCHT programs showed patient satisfaction rates over 90%, as well as an 88% reduction in nursing home bed days of care, a 63% reduction in VA nursing home admissions, and a 40% reduction in hospital emergency room visits (Office of …… 此处隐藏：25182字，全部文档内容请下载后查看。喜欢就下载吧 ……