spinal cord injury annual therapy evaluation through...
TRANSCRIPT
Spinal Cord Injury Annual Therapy Evaluation Through Telehealth: Improving Access,
Efficiency and Veteran Satisfaction
Prepared and presented by:Jana LaMarca, OTD, OTR/L, ATP, MSCS, Occupational Therapist, Spinal Cord Injury and Disorders Health Care Group, Veterans Health Administration, VA Long Beach Healthcare System, Long Beach, CA
Colin Lenington, OTD, OTR/L, ATP, CAPS Occupational Therapist, Spinal Cord Injury and Disorders Health Care Group, Veterans Health Administration, VA Long Beach Healthcare System, Long Beach, CA
Meghan Villalobos, RN, MSN, Telehealth Coordinator Spinal Cord Injury Outpatient Clinic, Veteran’s
Administration Hospital, Long Beach, CA
Disclosures
Jana LaMarca, Colin Lenington and Meghan Villalobos have no financial or non-financial interest to disclose.
This continuing education activity is managed and accredited by AffinityCE in cooperation with PVA. AffinityCE, PVA, as well as all accrediting organizations, do not support or endorse any product or service mentioned in this activity. Disclosure will be made when a product is discussed for an unapproved use.
AffinityCE staff and PVA Staff, as well as Planners and Reviewers, have no relevant financial or non-financial interests to disclose.
Commercial Support was not received for this activity
Learning Outcomes
At the conclusion of this activity, the participant will be able to:
1. Illustrate how offering telehealth therapy annuals improves access to care.
2. Demonstrate how offering telehealth therapy annuals can improve Veteran satisfaction.
3. Describe how offering telehealth therapy annuals increases overall efficiency.
Who identified this opportunity? Occupational Therapy department
Telehealth Coordinator
Admissions Coordinator
Inspiration: Using Telehealth for these services VA Telehealth Program Expansion
Anywhere to Anywhere Regulations
VA Video Connect
SCI Rehabilitation Programs Strategic Plan FY 19
Increase use of telehealth
Improve access
Improve timeliness of Service
Increase Veteran satisfaction
Evidence for Use of Telehealth in Rehabilitation
Allows for problem solving inside the home
Cost effective when compared to outpatient and in-home therapy models
Allows for holistic care
Reduces geographical constraints
Reduces medical constraints (travel)
Effective for use with people with Spinal Cord Injury, Multiple Sclerosis, and
Amyotrophic Lateral Sclerosis
What challenges did we answer?
Patient Access
TravelBurden
TimeBurden
Lost toFollow
-Up
SWOC analysis
• Challenges• Opportunities
• Weaknesses• Strengths
*Collaboration *Openness to innovation*Flexibility of schedule *Real time eval of Pt performing functional
activities in home
*Space availability *Camera availability *Coordination on the
front end.
*Expanding to pharmacy, social work, psychology, dietitian.
*More CVT visits.
*Pt difficulty with technology
*Pt reluctance to try something new
*Physical limitations of using technology
Admission coordinator contacts Patients to
schedule annual evaluation
Telehealth Coordinator contacts patient
Pre-Annual CVT Completed by Therapy
In-Person Follow-up
PRE-CVT PROCESS
1. Admission coordinator
contacts Patients to schedule annual
evaluation
2. Telehealth Coordinator
contacts patient
• Admission coordinator informs patient that telehealth therapy visits are now offered. Patients with opportunity to complete their visit in person or via Clinical Video Telehealth (CVT)
• If patient is interested, admissions coordinator alerts Telehealth Coordinator and Occupational Therapists (OT)
• Telehealth Coordinator determines what type of equipment is owned and needed to complete encounter
• Test call performed, training completed, changes made as needed until successful
• Patient scheduled in Tuesday Telehealth Therapy clinic slot
PRE-CVT PROCESS
3. Pre-Annual CVT Completed by
Therapy
4. In-Person Follow-up
• All components of therapy annual available to be completed via CVT are completed.
• Patient demonstrates functional or accessibility concerns in home as safe and able.
• Therapy and patient make plan for follow‐up as needed for training, equipment evaluation/repair, etc. during patient’s in‐person annual evaluation with remaining disciplines
• Scheduled as needed on same day as patient’s remaining components of annual evaluation during patient’s in‐person annual evaluation with remaining disciplines.
• Further follow‐up as needed. Future CVT coordinated between patient, Telehealth Coordinator and Therapy.
PRE-CVT PROCESS CONTINUED
What has been done? >30 Veterans have been seen for AE Therapy component via telehealth since
November 2018
Goal for fiscal year is 15 Veterans
Several are post-acute rehab
Feedback from persons served? Created satisfaction survey and just started administering, n= 8
Benefits of Therapy Pre-Annual CVT
Improves Patient Access
Reduces Travel Burden
Allows for triage ahead of
time.Improvesefficiency
Improves adherence to
therapy or home exercise plans
Allows for evaluation in home
environment
Increases Educational
Opportunities
Improves rapport, trust, and
satisfaction
Reduces missed opportunities
Performance Improvement Measures
Performance Improvement Patient Questionnaire
78%
18%
4%
Overall Response
Positive
Neutral
Negative100%
Efficiency of Annual
Improved
No Difference
Decreased
Outcomes continued
62%38%
Easier to Attend Annual
Easier
No Difference
Less Easy75%
25%
Value of AE Therapy CVT
More Valuable
Average Value
Less Valuable
37%
50%
13%
Helped to Understand Needs
More helpful
No Difference
Less Helpful
Outcomes continued
100%
Would Participate in CVT again in the Future
Very likely
Slightly likely
Neither likely orunlikely
Slightly unlikely86%
14%
Would Participate in CVT with Other Disciplines
Likely
Unlikely
Case Study 1: Mr. X Demographics
60 yr. old male
Married
Multiple Sclerosis
Lives 3+ hours away from SCI Center
Receiving care from SCI Center since 2010
Concerns Identified
Severe lymphedema in BLE
Functional mobility
Solutions
PWC evaluation with vendor scheduled for same day as annual evaluation
Mr. X suggests 3 way CVT as follow-up option with vendor and therapy
Case Study 2: Mr. Y Demographics
80 yr. old male
Lives alone
C4 Asia D Tetraplegia
Lives 3+ hours away from SCI Center
New to receiving services from SCI Center.
1st Annual Evaluation
Caregiver support 4 hrs./day
Concerns Identified
Injured >3 years ago with minimal rehab and no outpatient rehab
Bilateral wounds
Functional mobility/safety
Lack of Bowel/Bladder program
Home Access/Safety
ADL performance
No safe travel method
Solutions
Alerted assigned PACT and Rehab Team -> recommended inpatient follow-up
Arranged VA travel
Initiated Bridge to Independence Rehab program
Initiated functional mobility equipment evaluation
Initiated functional home evaluation
Case Study 3: Mr. Z Demographics
37 yr. old male
Lives with wife and 2 children (13 and 8)
Multiple Sclerosis dx in 2009
Lives in Las Vegas
New to receiving services from SCI Center.
1st Annual Evaluation
Concerns Identified
Mental Health
Functional mobility/safety
Lack of Bowel program
Home Access/Safety
ADL performance
Caregiver training and support
Solutions
Alerted assigned PACT and Rehab Team -> recommended inpatient follow-up
Initiated Bridge to Independence Rehab program
Initiated functional mobility equipment evaluation
Home evaluations Able to assess home safety for Veterans who are geographically far away
Prosthetics equipment evaluation (i.e. grab bars, ramps, stair glides, etc.)
Functional evaluation in context
Install follow-up
Unlimited follow-up opportunities in patient’s home
Reduced burden on patient and staff
Increased efficiency & productivity
>10 New Referrals Completed since November 2018
Future directions
Involve other services (i.e. Social Work, Psychology, Pharmacy, etc.)
Increase telehealth encounters in high need groups (i.e. Veterans with MS and ALS)
Group telehealth meetings and classes
Administer patient satisfaction questionnaire at Annual Evaluation in person.
Disseminate information for other providers/healthcare systems
ReferencesAmerican Occupational Therapy Association [AOTA] (2018). Telehealth in occupational therapy. American
Journal of Occupational Therapy, 72(Suppl. 2), 7212410059. https://doi.org/10.5014/ajot.2018.72S219
Cottrell, M., Galea, O., O’Leary, S., Hill, A., Russell, T. Real-time telerehabilitation for the treatment of musculskeletal conditions is effective and comparable to standard practice: A systematic review and meta-analysis. Clin Rehabil. 2016; May 2, 1-14.
Eklund, T. & Poskey, G. (2016). An appraisal of evidence on telehealth and quality of life of adults with multiple sclerosis. American Journal of Occupational Therapy, 70(4_Supplement_1), 7011505160p1-7011505160p1. https://doi.org/10.5014/ajot.2016.70S1-PO5112
Serwe, K., Hersch, G., Pickens, N., Pancheri, K., Caregiver Perceptions of a Telehealth Wellness Program. AJOT; 71, 7104350010.
Shein, R., Schmeler, M., Holm, M., Pramuka, M., Saptono, A., Brienza, D. Telerehabilitation assessment using the Functioning Everyday with a Wheelchair-Capacity instrument. J Rehabil Res Dev. 2011; 48(2), 115-24.
Stillerova, t., Liddle, J., Gustafsson, L., Lamont, R., Silburn, P. Could everyday technology improve access to assessments? A pilot study on the feasibility of screening cognition in people with Parkinson's disease using the Montreal Cognitive Assessment via Internet videoconferencing. AJOT. 2016; 63(6), 373-380.
Ullrich, P. M., Spungen, A. M., Atkinson, D., Bombardier, C. H., Chen, Y., Erosa, N. A., …& Tulsky, D. S. (2012). Activity and participation after spinal cord injury: State-of-the-art report. Journal of Rehabilitation Research & Development, 49(1). https://doi.org/10.1682/JRRD.2010.06.0108
Van den Berg, M., Crotty M., Liu, E., Killington, M., Kwakkel, G., Van Wegen, E. Early supported discharge by caregiver-mediated exercises and e-Health support after stroke. Stroke. 2016; 47(7), 1885-92.
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