期刊
TELEMEDICINE AND E-HEALTH
卷 27, 期 2, 页码 218-226出版社
MARY ANN LIEBERT, INC
DOI: 10.1089/tmj.2020.0013
关键词
teledermatology; telehealth; e-health; policy; dermatology
资金
- VA Office of Rural Health
- Center of Innovation to Accelerate Discovery & Practice Transformation (ADAPT) [CIN 13-410]
- Center for Healthcare Organization and Implementation Research (CHOIR) [CIN 13-403]
A systematic analysis of implementing teledermatology programs to serve rural veterans in the VA has shown high levels of implementation and sustainability, while also highlighting areas for improvement.
Introduction: Few systematic evaluations of implementing teledermatology programs in large health care systems exist. We conducted a longitudinal evaluation of a U.S. Department of Veterans Affairs (VA) initiative to expand asynchronous consultative teledermatology services for rural veterans. Methods: The reach, effectiveness, adoption, implementation, and maintenance framework guided the evaluation, which included analysis of quantitative VA administrative data as well as an online survey completed by participating facilities. The first 2 years of the program were compared with the year before the start of funding. Results: Sixteen hub facilities expanded teledermatology's reach over the 2-year period, increasing the number of referral spoke sites, unique patients served, and teledermatology encounters. Effectiveness was reflected as teledermatology constituted an increasing fraction of dermatology activity and served more remotely located patients. Adoption through defined stages of implementation progressed as facilities engaged in a variety of strategies to enhance teledermatology implementation, and facilitators and barriers were identified. Program maintenance was assessed by Program Sustainability Index scores, which reflected the importance of executive support, and ongoing concerns about staffing and longitudinal funding. Discussion: Enabling hubs to create solutions that best fit their needs and culture likely increased reach and effectiveness. Important facilitators included organizational leadership and encouraging communication between stakeholders before and during the intervention. Conclusions: A systematic analysis of teledermatology implementation to serve rural sites in VA documented a high degree of implementation and sustainability as well as areas for improvement.
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