Characterization of Telehealth Use in Veterans with Spinal Cord Injuries and Disorders

BACKGROUND: Individuals with spinal cord injuries and disorders (SCI/D) require frequent interdisciplinary health care to address impairments in mobility, autonomic functions, and secondary complications. Telehealth has the capacity to substantially transform healthcare delivery and improve care by increasing access and communication. However, relatively little is known about telehealth use in this specific population. Here, we attempt to fill part of this gap. OBJECTIVE: To investigate the frequency and characteristics associated with telehealth use in Veterans with SCI/D. DESIGN: Cross-sectional, descriptive project SETTING: Veterans Health Administration (VHA) facilities. Participants: 15,028 Veterans living with SCI/D whom received services from the VHA SCI/D System of Care. Intervention: Not applicable Outcome Measures: Frequency and characteristics associated with VHA telehealth utilization. Results: Of the 15,028 Veterans with SCI/D included in the evaluation, 17% used some form of telehealth in VHA Fiscal Year (FY)2017. Veterans over the age of 65 had lower odds (OR = 0.88, p \u3c 0.05, CI: 0.80-0.98) of using telehealth. Being Caucasian (OR = 1.29, p \u3c 0.01, CI: 1.09-1.52), living in rural areas (OR =1.16, p \u3c 0.01, CI: 1.05-1.28), living greater distances away from the VHA (p \u3c 0.01 for all distances), and being in priority group 8, meaning that Veterans have higher copayment requirements (OR=1.46, p \u3c 0.001, CI: 1.19-1.81), were all significantly associated with greater odds of telehealth use. The most frequent types of telehealth used were real-time clinical video and store-and-forward between a provider and patient within the same hub network. Conclusion: There are opportunities to increase telehealth adoption in the SCI/D arena. The findings from this project highlight which Veterans are currently using telehealth services, as well as gaps regarding telehealth adoption in this population

Documenting Elementary Teachers\u27 Sustainability of Instructional Practices: A Mixed Method Case Study

School reform programs focus on making educational changes; however, research on interventions past the funded implementation phase to determine what was sustained is rarely done (Beery, Senter, Cheadle, Greenwald, Pearson, et al., 2005). This study adds to the research on sustainability by determining what instructional practices, if any, of the Teaching SMART[reg] professional development program that was implemented from 2005-2008 in elementary schools with teachers in grades third through eighth were continued, discontinued, or adapted five years post-implementation (in 2013). Specifically, this study sought to answer the following questions: What do teachers who participated in Teaching SMART[reg] and district administrators share about the sustainability of Teaching SMART[reg] practices in 2013? What teaching strategies do teachers who participated in the program (2005-2008) use in their science classrooms five years post-implementation (2013)? What perceptions about the roles of females in science, technology, engineering, and mathematics (STEM) do teachers who participated in the program (2005-2008) have five years later (2013)? And, What classroom management techniques do the teachers who participated in the program (2005-2008) use five years post implementation (2013)? A mixed method approach was used to answer these questions. Quantitative teacher survey data from 23 teachers who participated in 2008 and 2013 were analyzed in SAS v. 9.3. Descriptive statistics were reported and paired t-tests were conducted to determine mean differences by survey factors identified from an exploratory factor analysis, principal axis factoring, and parallel analysis conducted with teacher survey baseline data (2005). Individual teacher change scores (2008 and 2013) for identified factors were computed using the Reliable Change Index statistic. Qualitative data consisted of interviews with two district administrators and three teachers who responded to the survey in both years (2008 and 2013). Additionally, a classroom observation was conducted with one of the interviewed teachers in 2013. Qualitative analyses were conducted following the constant comparative method and were facilitated by ATLAS.ti v. 6.2, a qualitative analysis software program. Qualitative findings identified themes at the district level that influenced teachers\u27 use of Teaching SMART[reg] strategies. All the themes were classified as obstacles to sustainability: economic downturn, turnover of teachers and lack of hiring, new reform policies, such as Race to the Top, Student Success Act, Common Core State Standards, and mandated blocks of time for specific content. Results from the survey data showed no statistically significant difference through time in perceived instructional practices except for a perceived decrease in the use of hands-on instructional activities from 2008 to 2013. Analyses conducted at the individual teacher level found change scores were statistically significant for a few teachers, but overall, teachers reported similarly on the teacher survey at both time points. This sustainability study revealed the lack of facilitating factors to support the continuation of reform practices; however, teachers identified strategies to continue to implement some of the reform practices through time in spite of a number of system-wide obstacles. This sustainability study adds to the literature by documenting obstacles to sustainability in this specific context, which overlap with what is known in the literature. Additionally, the strategies teachers identified to overcome some of the obstacles to implement reform practices and the recommendations by district level administrators add to the literature on how stakeholders may support sustainability of reform through time

Quality of Life Outcomes for Veterans With Spinal Cord Injury Receiving Individual Placement and Support (IPS)

Background: Individual Placement and Support (IPS) is an evidence-based practice that helps persons with mental and/or physical disabilities, including spinal cord injury, find meaningful employment in the community. While employment is associated with positive rehabilitation outcomes, more research is needed on the impact of IPS participation on non-vocational outcomes, particularly quality of life (QOL). Objective: To identity QOL outcomes experienced with (1) IPS participation and (2) IPS participation leading to employment. Methods: Using a mixed method design, data on quality of life outcomes were collected from 151 interviews and 213 surveys completed by veterans with SCI participating in IPS. Results: At 12 months, participants who obtained competitive employment (CE) and those who did not (no-CE) showed improvement on most measures. In months 12-24, the CE group showed improvements on all study measures while the no-CE group declined on many indices. Statistically significant changes were observed between participants who obtained CE versus no-CE on several measures. Themes were identified from interview data related to productivity and well-being. Productivity themes were (1) contributing to society, (2) earning an income, and (3) maintaining employment. Themes for well-being were (1) mental health/self-confidence, (2) physical health, and (3) goal setting. Themes were associated with IPS participation irrespective of employment outcomes. Conclusion: IPS participants who were competitively employed report consistent improvement in handicap, health-related QOL, and life satisfaction measures across time. Qualitative findings revealed improved QOL outcomes in productivity and well-being for veterans participating in IPS overall, regardless of employment outcomes

Virtual Medical Modality Implementation Strategies for Patient-Aligned Care Teams to Promote Veteran-Centered Care: Protocol for a Mixed-Methods Study

Background: The Veterans Health Administration (VHA) is making system-wide efforts to increase integrated use of health information technology (HIT), including My HealtheVet (MHV), the Veterans Affairs (VA) electronic patient portal, Vet Link kiosks, telehealth, and mobile apps. Integrated use of HIT can increase individual and system efficiency, maximize resources, and enhance patient outcomes. Prior research indicates that provider endorsement and reinforcement are key determinants of patient adoption of HIT. HIT implementation strategies need to reflect providers’ perspectives to promote adoption and endorsement of these tools; however, providers often lack awareness or are unmotivated to incorporate HIT into clinical care with their patients. When these modalities are used by patients, the approach is often fragmented rather than integrated within and across care settings. Research is needed to identify effective implementation strategies for increasing patient-aligned care team (PACT) member (ie, the VHA’s Patient Centered Medical Home) awareness and motivation to use HIT in a proactive and integrated approach with patients. Objective: This paper describes the rationale, design, and methods of the PACT protocol to promote proactive integrated use of HIT. Methods: In Aim 1, focus groups (n=21) were conducted with PACT members (n=65) along with questionnaires and follow-up individual interviews (n=16). In Aim 2, the team collaborated with VA clinicians, electronic health researchers and operational partners to conduct individual expert interviews (n=13), and an environmental scan to collect current and emerging provider-focused implementation tools and resources. Based on Aim 1 findings, a gap analysis was conducted to determine what implementation strategies and content needed to be adapted or developed. Following the adaptation or development of resources, a PACT expert panel was convened to evaluate the resultant content. In Aim 3, a local implementation of PACT-focused strategies to promote integrated use of HIT was evaluated using pre- and postquestionnaire surveys, brief structured interviews, and secondary data analysis with PACT members (n=63). Results: Study enrollment for Aim 1 has been completed. Aims 1 and 2 data collection and analysis are underway. Aim 3 activities are scheduled for year 3. Conclusions: This work highlights the practical, technological, and participatory factors involved in facilitating implementation research designed to engage PACT clinical members in the proactive integrated use of HIT. These efforts are designed to support the integrated and proactive use of VA HIT to support clinical care coordination in ways that are directly aligned with PACT member preferences. This study evaluated integrated VA HIT use employing mixed-methods and multiple data sources. Deliverables included PACT-focused strategies to support integrated use of HIT in the ambulatory care setting that will also inform strategy development in other systems of care and support subsequent implementation efforts at regional and national levels