QUERI – Quality Enhancement Research Initiative

TeleWound Practice Partnered Evaluation Initiative

Hines, IL

Overview:

Research has shown that the presence of wounds (i.e., diabetic foot ulcer) for Veterans is a more significant predictor of subsequent mortality than coronary artery disease, peripheral arterial disease, or stroke. Coupled with evidence that Veterans living in rural areas receive less specialized care than their urban counterparts due to transportation, time, and cost barriers, these factors emphasize the importance of increasing access to coordinated specialized wound care for rural Veterans. A specific program for providing wound care to Veterans using telehealth technologies (TeleWound Practice) has been shown to reduce travel time/costs and increase satisfaction with care during an early pilot, signifying the potential of this program to improve wound care at any VA medical center and, in particular, at facilities that serve a large number of Veterans living in rural or highly-rural settings.

The objective of this evaluation by QUERI’s TeleWound Practice Partnered Evaluation Initiative

is to identify issues related to the successful implementation of the TeleWound Practice and determine the extent to which TeleWound is successful in improving clinical and healthcare system outcomes when rolled out to other VA facilities. Primary aims include:

• Evaluating the implementation of the TeleWound Practice by:
  • Examining stakeholder perspectives of facilitators and barriers;
  • Assessing patient and provider satisfaction, observing processes and workflow; and
  • Testing the program’s reach by determining the number of patients using TeleWound Practice.
• Assessing the impact of TeleWound Practice on clinical outcomes related to wound care.
• Determining the impact of TeleWound Practice on healthcare system outcomes related to wound care.

Figure 1. Increasing EBQI Capacity
(adapted from Mery et al., 2017)

Methodology

Five VA facilities and their community-based outpatient clinics (CBOCs) from VISN15 (VA Heartland Network) are participating in the initial implementation of the program. To understand stakeholder perspectives regarding barriers and facilitators that influence successful implementation of TeleWound Practice across facilities, investigators will deploy surveys to TeleWound healthcare team members and will conduct interviews with stakeholders from these sites. QUERI investigators also will conduct surveys and interviews with Veterans who have received TeleWound care to learn about their experiences, including any barriers and facilitators, as well as patients’ perceptions of the program. Site visits will be conducted at two VAMCs and their CBOCs, which will allow investigators to observe the processes and workflow involved in conducting wound care visits over telehealth technologies. Using data from national databases, investigators will then examine the impact of TeleWound Practice on numbers of patients receiving wound care through telehealth, their clinical outcomes, and impact on healthcare system outcomes.

Anticipated Impacts

Evaluation of the rollout of TeleWound Practice in VISN15 will identify barriers and solutions in a small number of sites that can be used to successfully roll out TeleWound Practice nationally. It is expected that Veterans who receive TeleWound care services will have clinical outcomes that are the same or better than those who receive only in-person care. It also is anticipated that use of TeleWound Practice will reduce burden and costs for Veterans.

Corresponding Principal Investigators: Frances M. Weaver, PhD (Frances.Weaver@va.gov) and Bella Etingen, PhD (Bella.Etigen@va.gov ).

Operations Partners: VA’s Diffusion of Excellence, Connected Care, Office of Nursing Services (ONS), Podiatry Service, Spinal Cord Injuries and Disorders National Office