Expanded Care: The Department of Veteran's Affairs Telehealth Programs within Care Coordination Services

Tuesday, 14 July 2009

Deborah A. Harris-Cobbinah, RN, ANP, CNS, BC
Patient services, NEW York Dept. of Veterans Affairs, New York, NY

Learning Objective 1: describe evidence-based management of chronic disease using telehealth technology.

Learning Objective 2: assess available telehealth equipment within care coordinated services and intergate these devices into clinical practice.

Purpose:  . 
The Telehealth program was created by the Veterans Health Administration (VHA) to ensure that eligible veterans will have access to a comprehensive, integrated, continuum of high quality  healthcare that addresses medical and mental health needs of veterans in the community, through the use of Telehealth equipment and case management.
The Telehealth Program utilizes informatic technologies and telecommunication modalities to augment care provided by VHA and non VHA primary care providers.  The Telehealth staff has been given the responsibility to coordinate the veteran's care and services with both VHA and non-VHA resources to ensure appropriate continuity throughout the course of enrollment.

Methods:   After reviewing referral, an office appointment is made to review Telehealth program and usage of Telehealth home monitoring devices with patient. Veterans are encouraged to complete self report protocols daily, using the home monitor,that is connected to landline telephones. Each veteran is given a specific protocol according to his/her diagnosis.  If a high risk behavior or symptom is alerted , a Telehealth nurse will contact the veteran to assess if intervention is warranted. These interventions could include the following: notification of primary care provider, crisis intervention or consult referrals to VHA or non-VHA community services.

Results:  There has been a significant improvement in blood pressure readings and ACI measurement for veterans using Telehealth home monitoring devices. The number of hospital admissions and the length of stay have decreased in veterans using Telehealth monitors.  There has been marked improvement in veteran's compliance with clinic appointments and medication regimes.

Conclusion:  Telehealth services will facilitate access to care and improve health of designated individuals and populations with specific intent of providing the right care in the right place, at the right time.  This expanded care will improve chronic disease management, improve patient satisfaction, increase access to services and reduce resource utilization, thus decreasing healthcare costs.