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BACKGROUND/RATIONALE:
There is substantial evidence to support the use of a multi-disciplinary approach for the treatment of chronic wounds. While many large medical facilities have assembled these multi-disciplinary wound care teams, smaller centers, particularly in rural areas, lack the personnel and other resources necessary to support these efforts. Consequently, chronic wound patients in many VA facilities outside of major centers lack access to state-of-the-art wound care. Teleconsultation offers an opportunity to improve access to multi-disciplinary wound care teams for rural paitents, thus potentially reducing the incidence, clinical sequellae, and long-term costs of severely infected chronic wounds. However, there is currently no data available on whether or not teleconsultation can actually achieve the expected improvements in quality of care and reduction in morbidity.
OBJECTIVE(S):
The primary objective of the proposed research is to conduct an evaluation of the first six months of the VISN 11 wound care teleconsultation program in the Battle Creek VA Medical Center and Grand Rapids Outpatient Clinic. Study hypotheses will examine the following: (1) utilization of services; (2) use of state-of-the-art treatment modalities; (3) amputation rates; and (4) quality of care as measured by various process indicators. Data collected from this study will provide important preliminary data for the conduct of a larger scale, multi-site evaluation of this new delivery program. The secondary objective of the proposed research is to survey all of the VISNs (and a sample of VAMCs, as recommended by VISN staff) to identify the current infrastructure for managing chronic wounds, both in primary and tertiary care facilities. This information will then be used to select two VISNs (intervention and control) for inclusion in a December 2008 SDP to roll-out wound care teleconsultation to multiple sites.
METHODS:
The study will consist of a quasi-experimental design comparing patients enrolled in the first six months of the VISN 11 teleconsultation program with an historical control group of chronic wound patients seen at the Battle Creek VAMC and Grand Rapids OPC in 2005. To complete a preliminary evaluation of the teleconsultation program by the end of FY '08, patients in both the intervention and control groups will be followed for 3-6 months. Data sources will include Austin databases for demographics, comorbidities, resource utilization, and amputation rates. VA's Computerized Patient Record System (CPRS) will be used to obtain data on wound type, duration, treatments, and processes of care. Analyses comparing the two study groups will be conducted primarily using linear regression techniques, including Poisson regression for the utilization data, and logistic regression for the process and treatment data. Data collection for the secondary objective will be done primarily via interviews, both on the phone and in-person, and analyses will be descriptive.
FINDINGS/RESULTS:
None yet.
IMPACT:
It is expected that this research will improve access to high quality care for patients with chronic wounds.
PUBLICATIONS:
None at this time.
DRA:
none
DRE:
none
Keywords:
none
MeSH Terms:
none
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