Abstract

BackgroundTelehealth has potential to help individuals in rural areas overcome geographical barriers and to improve access to care. The factors that influence the implementation and use of telehealth in critical access hospitals are in need of exploration.ObjectiveThe aim of this study is to understand the factors that influenced telehealth uptake and use in a set of frontier critical access hospitals in the United States.MethodsThis work was conducted as part of a larger evaluation of a Centers for Medicare & Medicaid Services–funded demonstration program to expand cost-based reimbursement for services for Medicare beneficiaries for frontier critical access hospitals. Our sample was 8 critical access hospitals in Montana, Nevada, and North Dakota that implemented the telehealth aspect of that demonstration. We reviewed applications and progress reports for the demonstration program and conducted in-person site visits. We used a semistructured discussion guide to facilitate conversations with clinical, administrative, and information technology staff. Using NVivo software (QSR International), we coded the notes from the interviews and then analyzed the themes.ResultsSeveral factors influenced the implementation and use of telehealth in critical access hospitals, including making changes to workflow and infrastructure as well as practitioner acceptance and availability. Participants also cited technical assistance and support for implementation as supportive factors.ConclusionsFrontier critical access hospitals may adopt telehealth to overcome challenges such as distance from specialty practitioners and workforce challenges. Telehealth can be used for provider-to-patient and provider-to-provider interactions to improve access to care, remove barriers, and improve quality. However, the ability of telehealth to improve outcomes is limited by factors such as workflow and infrastructure changes, practitioner acceptance and availability, and financing.

Highlights

  • Telehealth has potential to help individuals in rural areas overcome geographical barriers and to improve access to care

  • Telehealth can be used for provider-to-patient and provider-to-provider interactions to improve access to care, remove barriers, and improve quality

  • critical access hospital Centers for Medicare & Medicaid Services (CMS) (CAH) expanded their capabilities to provide different types of services via telehealth with the hope that these new services would allow more community members to remain in the local community for care

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Summary

Introduction

Telehealth has potential to help individuals in rural areas overcome geographical barriers and to improve access to care. Barriers to access include travel time, transportation, cost, and other logistical considerations, which telehealth can help address [1]. Access to care can be enhanced through telehealth to connect practitioners and patients who are not co-located, which enables patients to receive care that is not otherwise available locally. Many rural areas are not adequately served by practitioners; routine follow-up can involve extensive travel, resulting in delays in receiving care, missed appointments, and other issues [4,5]. Telehealth can promote improved adherence to care plans and can contribute to https://formative.jmir.org/2021/5/e24118. The factors that influence the implementation and use of telehealth in critical access hospitals are in need of exploration

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