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Using Telehealth Technology to Increase Specialized Wound Care for Veterans in Rural Settings

Research has shown that the presence of chronic wounds for Veterans is a more significant predictor of subsequent mortality than coronary artery disease, peripheral arterial disease, or stroke. Coupled with evidence that Veterans living in rural areas receive less specialized care than their urban counterparts due to transportation, time, and cost barriers, these factors emphasize the importance of increasing access to coordinated specialized wound care for rural Veterans. A specific program for providing wound care to Veterans using telehealth technologies (TeleWound Practice) has been shown to reduce travel time/costs and increase satisfaction with care, signifying the potential of this program to improve wound care at any VA medical center and at facilities that serve a large number of Veterans living in rural or highly rural settings, in particular.

QUERI’s TeleWound Practice Partnered Evaluation Initiative is working to identify issues related to the successful implementation of the TeleWound Practice and determine the extent to which TeleWound is successful in improving clinical and healthcare system outcomes when rolled out to other VA facilities. Primary aims include:

• Evaluating 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 the program’s reach by determining the number of patients using TeleWound Practice.
• Assessing the impact of TeleWound Practice on clinical and health system outcomes related to wound care.

Collaboration

Telewound QUERI is partnering with VA’s Diffusion of Excellence, Connected Care, Office of Nursing Services (ONS), Podiatry Service, and the Spinal Cord Injuries and Disorders National Office. In addition, five VA facilities and their community-based outpatient clinics (CBOCs) from VISN 15 (VA Heartland Network) are participating in the initial implementation of the program.

To understand stakeholder perspectives regarding barriers and facilitators that influence successful implementation of TeleWound Practice across facilities, investigators will deploy surveys to TeleWound healthcare team members and will conduct interviews with stakeholders from these sites. QUERI investigators also will conduct surveys and interviews with Veterans who have received TeleWound care to learn about their experiences, including any barriers and facilitators, as well as their perceptions of the program. Site visits will be conducted at two VAMCs and their CBOCs, which will allow investigators to observe the processes and workflow involved in conducting wound care visits over telehealth technologies. Using data from national databases, investigators will then examine the impact of TeleWound Practice on numbers of patients receiving wound care through telehealth, their clinical outcomes, and impact on healthcare system outcomes.

Expected Impacts

Evaluation of the rollout of TeleWound Practice in VISN 15 will identify barriers and solutions that can inform larger roll out of TeleWound Practice nationally. It is expected that Veterans who receive TeleWound care services will have clinical outcomes that are the same or better than those who receive only in-person care. It also is anticipated that the use of TeleWound Practice will reduce burden and costs for Veterans, informing the return on investment for national leadership.

For more information about Telewound QUERI, please contact Dr. Fran Weaver at Frances.Weaver@va.gov or Dr. Bella Etingen at Bella.Etigen@va.gov .