Low-Tech High-Value(s) Care: No Patient Left Behind

Alkureishi, Maria Alcocer; Lee, Wei Wei; Lenti, G; Choo, Zi-Yi; Benning-Shorb, Jonah; Grob, Rachel; Gaines, Martha E.; Frankel, Richard M.

doi:10.7812/tpp/21.083

Cited by 3 publications

(7 citation statements)

References 20 publications

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“…To overcome these challenges and bridge telehealth gaps, WH coaches have integrated multiple modalities into their coaching practice; for example, using in-person, video telehealth, and non-internet reliant options, such as telephone, DVDs, and mail outs. Moreover, rather than employing a “one-size-fits-all” approach, our findings suggest that coaches should apply a pragmatic and blended approach of various modalities based on the Veterans’ contexts, needs, and preferences, which exemplifies a patient-driven approach to care ( 16 , 19 , 37 , 38 ).…”

Section: Discussionmentioning

confidence: 95%

“…Future studies are warranted to examine the impact of increased telehealth delivery and how to approach equitable access to telehealth in a way that does not favor one group over another (38,41,45). Amid higher tech advancements and implementation, it is important to also acknowledge the advantages of lower tech modalities for WH coaching (37). Telephone health coaching was highlighted as a preferred approach for WH delivery by many participants due to its convenience, suitability, and easy availability among rural Veterans.…”

Section: Discussionmentioning

confidence: 99%

“…As digital forms of telehealth continue to be rolled out, ensuring equitable access to technology is not only a necessity but also ethically important. Establishing reliable broadband infrastructure for rural and other underserved populations must be addressed so as to not exacerbate the already existing digital divide ( 44 ) and health disparities among rural vs. urban and older vs. younger Veterans ( 4 , 37 , 38 , 45 ). There are many opportunities to bridge these gaps.…”

Section: Discussionmentioning

confidence: 99%

“…Amid higher tech advancements and implementation, it is important to also acknowledge the advantages of lower tech modalities for WH coaching ( 37 ). Telephone health coaching was highlighted as a preferred approach for WH delivery by many participants due to its convenience, suitability, and easy availability among rural Veterans.…”

Section: Discussionmentioning

confidence: 99%

“…However, phone appointments can sometimes receive less workload credit than video telehealth or in-person care. Therefore, it is critical to advocate that telephone coaching remains a billable form of contact so that more coaches are willing to utilize this option with those Veterans who prefer this modality over others ( 37 ) or who may have to rely on phone-based telehealth services due to undependable or inconsistent video connectivity.…”

Section: Discussionmentioning

confidence: 99%

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Whole Health coaching to rural Veterans through telehealth: Advantages, gaps, and opportunities

LeBeau

Varma

Kreider

et al. 2023

Front. Public Health

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BackgroundThe Veterans Health Administration (VHA) is one of the largest providers of telehealth in the United States and continues to lead the way in transforming healthcare services. VHA has been implementing its Whole Health (WH) initiative since 2018, a proactive practice empowering patients to take charge of their health and well-being. A key facilitator of the WH initiative is the WH coach who partners with Veterans to achieve their health-related goals. A gap exists in the literature regarding the understanding of WH coaches’ use of telehealth to engage rural-residing Veterans. COVID-19 unexpectedly interrupted in-person VHA delivery of care, including WH coaching which primarily relied on in-person delivery and focused less on telehealth. During the pandemic, WH coaches had to adapt and integrate different modalities to engage their Veteran patients. We examined WH coaches’ approaches to extending coaching to rural Veterans via technology, emphasizing the advantages of telehealth, existing gaps in telehealth delivery, and opportunities for telehealth as a coaching modality.MethodsThis project was implemented as part of a larger mixed methods evaluation regarding WH coaching for rural Veterans; this manuscript presents the findings from the qualitative data from the larger study. The qualitative dataset is comprised of data collected using three different qualitative methods: four focus groups (n = 11; 3–4 participants per group), in-depth individual interviews (n = 9), and open-ended responses from a national web-based survey (n = 140). Focus group, in-depth interview, and open-ended survey data were collected sequentially and separately analyzed following each wave of data collection. Findings from the three analyses were then collaboratively merged, compared, reorganized, and refined by the evaluation team to create final themes.ResultsThree final themes that emerged from the merged data were: (1) Advantages of Telehealth; (2) Telehealth Gaps for Rural Veterans, and (3) Strategies for Bridging Telehealth Gaps. Themes explicate telehealth advantages, gaps, and opportunities for rural Veteran WH coaching.ConclusionFindings highlight that video telehealth alone is not sufficient for meeting the needs of rural Veterans. Digital technologies hold promise for equalizing health access gaps; however, both human factors and broadband infrastructure constraints continue to require WH coaches to use a mix of modalities in working with rural Veterans. To overcome challenges and bridge gaps, WH coaches should be ready to adopt a blended approach that integrates virtual, in-person, and lower-tech options.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Whole Health coaching to rural Veterans through telehealth: Advantages, gaps, and opportunities

LeBeau

Varma

Kreider

et al. 2023

Front. Public Health

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A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study

Brown‐Johnson¹,

Lessios²,

Thomas³

et al. 2023

JMIR Form Res

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Background Innovative solutions to nursing care are needed to address nurse, health system, patient, and caregiver concerns related to nursing wellness, work flexibility and control, workforce retention and pipeline, and access to patient care. One innovative approach includes a novel health care delivery model enabling nurse-led, off-hours wound care (PocketRN) to triage emergent concerns and provide additional patient health education via telehealth. Objective This pilot study aimed to evaluate the implementation of PocketRN from the perspective of nurses and patients. Methods Patients and part-time or per-diem, wound care–certified and generalist nurses were recruited through the Stanford Medicine Advanced Wound Care Center in 2021 and 2022. Qualitative data included semistructured interviews with nurses and patients and clinical documentation review. Quantitative data included app use and brief end-of-interaction in-app satisfaction surveys. Results This pilot study suggests that an app-based nursing care delivery model is acceptable, clinically appropriate, and feasible. Low technology literacy had a modest effect on initial patient adoption; this barrier was addressed with built-in outreach and by simplifying the patient experience (eg, via phone instead of video calls). This approach was acceptable for users, despite total patient enrollment and use numbers being lower than anticipated (N=49; 17/49, 35% of patients used the app at least once beyond the orientation call). We interviewed 10 patients: 7 who had used the app were satisfied with it and reported that real-time advice after hours reduced anxiety, and 3 who had not used the app after enrollment reported having other resources for health care advice and noted their perception that this tool was meant for urgent issues, which did not occur for them. Interviewed nurses (n=10) appreciated working from home, and they reported comfort with the scope of practice and added quality of care facilitated by video capabilities; there was interest in additional wound care–specific training for nonspecialized nurses. Nurses were able to provide direct patient care over the web, including the few participating nurses who were unable to perform in-person care (n=2). Conclusions This evaluation provides insights into the integration of technology into standard health care services, such as in-clinic wound care. Using in-system nurses with access to electronic medical records and specialized knowledge facilitated app integration and continuity of care. This care delivery model satisfied nurse desires for flexible and remote work and reduced patient anxiety, potentially reducing postoperative wound care complications. Feasibility was negatively impacted by patients’ technology literacy and few language options; additional patient training, education, and language support are needed to support equitable access. Adoption was impacted by a lack of perceived need for additional care; lower-touch or higher-acuity settings with a longer wait between visits could be a better fit for this type of nurse-led care.

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A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study (Preprint)

Brown-Johnson,

Lessios,

Thomas

et al. 2022

Preprint

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BACKGROUND Innovative solutions to nursing care are needed to address nurse, health system, patient, and caregiver concerns related to nursing wellness, work flexibility and control, workforce retention and pipeline, and access to patient care. One innovative approach includes a novel health care delivery model enabling nurse-led, off-hours wound care (PocketRN) to triage emergent concerns and provide additional patient health education via telehealth. OBJECTIVE This pilot study aimed to evaluate the implementation of PocketRN from the perspective of nurses and patients. METHODS Patients and part-time or per-diem, wound care–certified and generalist nurses were recruited through the Stanford Medicine Advanced Wound Care Center in 2021 and 2022. Qualitative data included semistructured interviews with nurses and patients and clinical documentation review. Quantitative data included app use and brief end-of-interaction in-app satisfaction surveys. RESULTS This pilot study suggests that an app-based nursing care delivery model is acceptable, clinically appropriate, and feasible. Low technology literacy had a modest effect on initial patient adoption; this barrier was addressed with built-in outreach and by simplifying the patient experience (eg, via phone instead of video calls). This approach was acceptable for users, despite total patient enrollment and use numbers being lower than anticipated (N=49; 17/49, 35% of patients used the app at least once beyond the orientation call). We interviewed 10 patients: 7 who had used the app were satisfied with it and reported that real-time advice after hours reduced anxiety, and 3 who had not used the app after enrollment reported having other resources for health care advice and noted their perception that this tool was meant for urgent issues, which did not occur for them. Interviewed nurses (n=10) appreciated working from home, and they reported comfort with the scope of practice and added quality of care facilitated by video capabilities; there was interest in additional wound care–specific training for nonspecialized nurses. Nurses were able to provide direct patient care over the web, including the few participating nurses who were unable to perform in-person care (n=2). CONCLUSIONS This evaluation provides insights into the integration of technology into standard health care services, such as in-clinic wound care. Using in-system nurses with access to electronic medical records and specialized knowledge facilitated app integration and continuity of care. This care delivery model satisfied nurse desires for flexible and remote work and reduced patient anxiety, potentially reducing postoperative wound care complications. Feasibility was negatively impacted by patients’ technology literacy and few language options; additional patient training, education, and language support are needed to support equitable access. Adoption was impacted by a lack of perceived need for additional care; lower-touch or higher-acuity settings with a longer wait between visits could be a better fit for this type of nurse-led care.

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Low-Tech High-Value(s) Care: No Patient Left Behind

Cited by 3 publications

References 20 publications

Whole Health coaching to rural Veterans through telehealth: Advantages, gaps, and opportunities

Whole Health coaching to rural Veterans through telehealth: Advantages, gaps, and opportunities

A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study

A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study (Preprint)

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