Telehealth and Occupational Therapy: Integral to the Triple Aim of Health Care Reform.

Programs and concepts included in the Patient Protection and Affordable Care Act of 2010 are expected to transform health care in the United States from a volume-based health system to a value-based health system with increased emphasis on prevention and health promotion. The Triple Aim, a framework set forth by the Institute for Healthcare Improvement, focuses on improving the health care experience, the health of populations, and the affordability of care. This article describes telehealth as an integral component in achieving the Triple Aim of health care and discusses implications for occupational therapy practitioners.

Development and Validation of the Protocol for Administering Telehealth Home (PATH) Assessments.

Home safety assessments and subsequent modifications can prevent hospitalization, institutionalization, and death among older adults. Telehealth has been shown to be an effective means to administer home safety assessments. However, a structured approach to synchronous telehealth home assessments has not been examined. This study involved development and validation of a structured telehealth home assessment protocol. The Protocol for Administering Telehealth Home (PATH) assessment was developed based on literature review, clinical experience with in-person and telehealth home assessments, and interviews with content experts. Six older adults participated in the validation phase of the protocol using a quasi-experimental, mixed-methods, one-group research design. The validation process resulted in modifications to the protocol to enhance its utility in practice. The PATH protocol provides a valid, structured approach to conducting synchronous telehealth home assessments and can be used by occupational therapists to administer home assessments for older adults desiring to age in place.

Toward successful future use of telehealth in occupational therapy practice: What the COVID-19 rapid shift revealed.

BACKGROUND: Prior to the onset of the COVID-19 pandemic, occupational therapy (OT) services delivered through telehealth demonstrated comparative effectiveness to in-person services. At the onset of the pandemic, occupational therapy practitioners (OTPs) needed to continue delivering care to clients without being in-person. Many OT practitioners pivoted rapidly to telehealth, in many instances, with very little training. OBJECTIVE: The objective of this study was to describe the use of telehealth in occupational therapy during the early stages of the pandemic, and to explore how participants traversed the barriers. The perceived benefits and barriers to success with rapid telehealth adoption as experienced by OTPs, along with the specific strategies used to promote favorable outcomes may inform ongoing successful telehealth use in occupational therapy. METHOD: This study used a mixed-methods sequential explanatory design. Data was collected from September to December 2020 with an electronic survey. RESULTS: A total of 193 OTPs completed the survey, representing the delivery of OT services in 13 countries. Three main barriers to the use of telehealth were availability of materials, mastery of technology, and collaboration with caregivers/e-helpers. These barriers were negatively and significantly correlated with the participants' confidence level in the use of telehealth. Participants overcame barriers by independently obtaining telehealth training, including training within one's organization, support from social media, self-directed learning, and paid online telehealth webinars. CONCLUSION: Employers and educators can remove barriers to telehealth use by OTPs by providing a variety of learning opportunities and supports to enhance practitioners' confidence, thus increasing the likelihood of continued use of telehealth as a powerful and gap-bridging delivery model in occupational therapy.

Keeping Pace With 21st Century Healthcare: A Framework for Telehealth Research, Practice, and Program Evaluation in Occupational Therapy.

The use of telehealth to deliver occupational therapy services rapidly expanded during the COVID-19 pandemic. There are frameworks to evaluate services delivered through telehealth; however, none are specific to occupational therapy. Therefore, occupational therapy would benefit from a framework to systematically evaluate components of telehealth service delivery and build evidence to demonstrate the distinct value of occupational therapy. The PACE Framework outlines four priority domains to address areas of need: (1) Population and Health Outcomes; (2) Access for All Clients; (3) Costs and Cost Effectiveness; and (4) Experiences of Clients and Occupational Therapy Practitioners. This article describes the development and expert reviewer evaluation of the PACE Framework. In addition, the PACE Framework's domains, subdomains, and outcome measure examples are described along with future directions for implementation in occupational therapy research, practice, and program evaluation.

Stimulating Research to Advance Evidence-Based Applications of Telehealth in Occupational Therapy.

Occupational therapy focuses on therapeutic means to address participation in meaningful everyday tasks across the lifespan. No single setting is more conducive to this pursuit than individuals' authentic contexts. Occupational therapists are therefore uniquely suited to lead the charge toward stimulating research and advancing evidence-based application of telehealth. To this end, the American Occupational Therapy Foundation digitally convened their 2020 Planning Grant Collective to focus on the topic of Telehealth. Participants of the interdisciplinary collective collaboratively identified four themes: (1) Using technology to assess and intervene in the everyday context, (2) Partnerships with caregivers, (3) Telehealth delivery, and (4) Uniform data collection. Subgroups explored potential research and funding opportunities in their specialty area while also addressing the centralizing concepts of equity and diversity of telehealth delivery and COVID-19. Here, we provide a summary of the key concepts and recommendations from the 3 days of collaboration.

Best Practices for Building Interprofessional Telehealth: Report of a Conference.

The Arizona Biomedical Research Centre (ABRC) has funded a series of workshops and conferences since 2016 to build the capacity of local, tribal, and state agencies, healthcare delivery organizations, and non-governmental organizations to engage in meaningful research related to health disparities. With the COVID-19 pandemic, the use of telehealth has dramatically increased, particularly in nursing, occupational therapy (OT), physical therapy (PT), and speech-language pathology (SLP). The purpose of this paper is to summarize the presentations and discussion from the conference titled "Telerehabilitation and Telepractice: An Interprofessional Conference to Build Connections and Best Practices," held remotely on March 4-5, 2021. Terminology and concepts from the conference were debated, modified, and refined, based on an interprofessional audience. Presenters at the conference, all leaders in their field, discussed the current status of telehealth in their professions, including best practices, challenges, future trends, and research needs.

Telehealth is Face-to-Face Service Delivery.

The Commentary contests the increasingly outdated and narrow use of the terminology 'face-to-face' (often abbreviated as F2F) to connote clinical interactions in which both the client and the practitioner are physically present in the same room or space. An expanded definition is necessary because when delivered synchronously via videoconferencing, telehealth also provides face-to-face services (i.e., the practitioner and the client view each other's faces). Terminology that uses face-to-face to connote only in-person care is limiting and perpetuates language that is out of line with progressive US regulatory language and broad interpretation within existing regulatory language. It is this author's hope that this commentary will raise awareness of the important policy implications associated with this seemingly minor distinction in terminology and impact the lingering misapplication of the term, face-to-face.

American Telemedicine Association's Principles for Delivering Telerehabilitation Services.

Telehealth is a broad term used to describe the use of electronic or digital information and communications technologies to support clinical healthcare, patient and professional health related education, and public health and health administration. Telerehabilitation refers to the delivery of rehabilitation and habilitation services via information and communication technologies (ICT), also commonly referred to as" telehealth" technologies. Telerehabilitation services can include evaluation, assessment, monitoring, prevention, intervention, supervision, education, consultation, and coaching. Telerehabilitation services can be deployed across all patient populations and multiple healthcare settings including clinics, homes, schools, or community-based worksites. This document was adapted from the American Telemedicine Association's (ATA) "A Blueprint for Telerehabilitation Guidelines" (2010) and reflects the current utilization of telerehabilitation services. It was developed collaboratively by members of the ATA Telerehabilitation Special Interest Group, with input and guidance from other practitioners in the field, strategic stakeholders, and ATA staff. Its purpose is to inform and assist practitioners in providing effective and secure services that are based on client needs, current empirical evidence, and available technologies. Rehabilitation professionals, in conjunction with professional associations and other organizations are encouraged to use this document as a resource for developing discipline-specific standards, guidelines, and practice requirements.

Editors' Note.

The Spring 2016 issue of the International Journal of Telerehabilitation (IJT) presents original and innovative work in three diverse sections: usability, intervention, and pedagogy, followed by a book review on teleaudiology. The contributors to this issue are notably multi-disciplinary and include an audiologist, computer scientists, engineers, an epidemiologist, occupational therapists, a rehabilitation counselor, a physician (physical medicine and rehabilitation), and speechlanguage pathologists. The common thread linking the Journal's authors and their manuscripts, is excellence in telerehabilitation related innovation.

Editors' Note.

The Spring 2015 issue of the International Journal of Telerehabilitation (IJT) contains original research that analyzes provider perspectives on the use of telepractice to serve the families of children who are deaf or hard of hearing. Two case studies examine the utility of administering Facial Affect Training through telepractice to individuals with chronic traumatic brain injury. An article in IJT's policy section describes the process for the formulation of the World Federation of Occupational Therapists (WFOT) international telehealth position statement for occupational therapy. The World Federation of Occupational Therapists (WFOT) consists of 84 member organizations representing over 420,000 occupational therapists internationally (WFOT, 2014). The Spring 2015 issue also contains announcements of upcoming conferences. As of May 2015, the International Journal of Telerehabilitation (IJT) is live on PubMed Central: http://www.ncbi.nlm.nih.gov/pmc/journals/2411/. Articles from all past issues were indexed, as will be the current and future issues.