Abstract 378: A Needs Assessment Survey to Improve Utilization of Home Telehealth Services for Veterans at a VA Facility

Abstract

Objectives: The US Department of Veterans Affairs (VA) has been a leader in the use of Home Telehealth (HT) to monitor the health status and promote self-care for Veterans. VA’s HT services use standardized Disease Management Protocols (DMP) and telehealth technologies to target care and case management to improve access to care, improving the health of veterans. With HT, the location of health care services shift to the homes of Veterans receiving routine care. Current technologies include in-home devices from six vendors that ask the patient several daily questions regarding symptoms and vital signs and return the answers to the medical record. In collaboration with the HT program at the Palo Alto VA Health Care System (PA VAHCS), the VA’s Chronic Heart Failure (CHF) QUERI conducted a needs assessment survey with the PA VAHCS providers to help understand the provider’s view of HT and to understand any reasons for lack of enrollment. Method: A 9-item semi structured survey was developed and pilot-tested. The questions asked about use of HT program and referral of Veterans to HT program. The survey was sent to all providers at the PA VAHCS (n=198) and the response rate was 50% (n=89). Quantitative data analyses were conducted using descriptive statistics and chi-square tests. Results: The providers (respondents) were MD/DO (29.2%), RN (25.8%), LVN (21.3%), RNP (9.0%), pharmacists (7.9%), social workers (3.4%) and others (3.4%). Overall, 93% (n=83) of these providers knew about the available HT services. Among them, 57.8% reported that they refer Veterans more than 1-3 times a year to HT for heart failure (57.1%), diabetes (53.2%), hypertension (54.5%), COPD (31.0%) and depression (9.8%). A majority of all providers (73%) wanted all Veterans interested in HT be referred directly (without requiring primary care provider approval) and most of them want HT to utilize standard order sets for managing aspects of chronic self-care for Veterans with heart failure (87.5%), diabetes (89.2%), hypertension (87.7%), COPD (88.0%) and depression (79.1%). Patient refusal (38.2%) and time/effort required by the primary care provider for reviewing HT notes (21.3%) were the significant barriers experienced in referring Veterans to HT for screening. Conclusions: Providers were aware of home telehealth though only about half chose to refer patients. Providing direct enrollment in home telehealth (e.g. through a survey of interested patients with heart failure) may decrease a provider barrier and improve enrollment.