Predictors of attrition in older users of a home-based monitoring and health information delivery system.

OBJECTIVE: This retrospective study evaluated predictors of attrition in data from veterans with chronic medical conditions who were enrolled in a Veterans Administration Care Coordination Home Telehealth program. SUBJECTS AND METHODS: Data were collected over a 4-year period. The enrolled sample was 73 veterans, 55.3% of whom discontinued enrollment during this period. RESULTS: Among the selected variables examined, program discontinuation was assessed within the first 30 days of enrollment by response frequency to the home telehealth device. Intermittent device response was associated with earlier dropout. Enrollment in the program via telephone (rather than in person) was the largest predictor of premature dropout. CONCLUSIONS: To ensure sustained home telehealth utilization, it is essential to engage patients through encouraging active and regular responding to the provider through the home telehealth device within the first 30 days of program initiation.

The Care Coordination Home Telehealth (CCHT) rural demonstration project: a symptom-based approach for serving older veterans in remote geographical settings.

INTRODUCTION: Innovative healthcare delivery strategies are needed to address the healthcare needs of the 3.5 million older veterans living in US rural areas who face unique healthcare delivery challenges, including transportation barriers, poverty, and limited access to health professions and community-based programs. The care coordination home telehealth (CCHT) rural demonstration project was developed to address the mismatch between the timely identification of patient needs and the care delivered by the traditional disease-oriented institutionally-based healthcare delivery system for older rural veterans. The specific objectives were to: (1) serve as a facilitator of primary care; and (2) provide a portfolio of geriatric care management options to increase early detection of symptoms and to encourage adherence to care plans. METHODS: Participants were recruited based on patterns of high outpatient, inpatient, and emergency care visits; 132 rural older veterans were enrolled. The CCHT applied care management principles to the delivery of healthcare services and used health informatics to facilitate access to evidence-based care. The CCHT's essential components, which were tailored to optimize remote access, included a face-to-face orientation, telephone contact with a designated care coordinator, and daily monitoring sessions using an in-home telehealth device to assess participants' medication usage, compliance, and symptoms, and to provide patient education. RESULTS: One hundred eleven participants successfully installed and connected the telehealth monitoring device in their homes without hands-on assistance, monitored complex medical and psychiatric symptoms, and reported medication compliance remotely. Of the 93 participants who used the device for more than 10 sessions, 88 reported they did not have any difficulty using the device, 86 reported they were satisfied or very satisfied with the device, 73 reported they were likely to continue using the device, and 46 reported improved communication between themselves and their primary healthcare provider. CONCLUSION: Initial utilization and satisfaction evaluation data from this project supports the feasibility of employing a CCHT approach to serve medically-complicated older veterans in rural settings. This approach could also serve as a template for addressing a greater range of healthcare needs among other populations in hard-to-reach settings.

VA Puget Sound Telemental Health Service to rural veterans: a growing program.

The VA Puget Sound Health Care System Telemental Health program connects veterans with psychologists, psychiatrists, and social workers via live clinical video teleconferencing. Providers deliver care to veterans in rural Veteran Affairs medical centers, community-based outpatient clinics and residences, and thus, increase access to specialty mental health care for rural and medically underserved veteran communities.

Reaching out to older veterans in need: the Elko clinic demonstration project.

CONTEXT: The challenge of providing meaningful health care services to veterans living in rural communities is a major public health concern that involves redefining the traditional facility-based model of care delivery employed in urban areas. PURPOSE: This paper describes the steps of a demonstration project, the Elko Telehealth Outreach Clinic. The clinic, located in Elko, Nevada, was created to meet the health care needs of veterans who expressed a desire for greater access to VA services. METHODS: The Elko Telehealth Outreach Clinic is a specific example of the real-life implementation of the community-as-partner model as an operational framework for coordinating local, regional, and VA resources. The Elko Clinic provides a limited set of health care services including medication management, health education, prescription refills, routine lab tests, and specialty services through telehealth. FINDINGS: From December 2006 to December 2007, a total of 84 unique veterans received health care services through the Elko Clinic. CONCLUSIONS: Our findings support the usefulness of an expanded community-as-partner model to guide a process for addressing the health care needs of veterans in Elko, Nevada, and they have implications for the development and maintenance of outreach clinics in other rural settings.