Matthew Brooks

Telehealth and patient satisfaction: a systematic review and narrative analysis

Background The use of telehealth steadily increases as it has become a viable modality to patient care. Early adopters attempt to use telehealth to deliver high-quality care. Patient satisfaction is a key indicator of how well the telemedicine modality met patient expectations. Objective The objective of this systematic review and narrative analysis is to explore the association of telehealth and patient satisfaction in regards to effectiveness and efficiency. Methods Boolean expressions between keywords created a complex search string. Variations of this string were used in Cumulative Index of Nursing and Allied Health Literature and MEDLINE. Results 2193 articles were filtered and assessed for suitability (n=44). Factors relating to effectiveness and efficiency were identified using consensus. The factors listed most often were improved outcomes (20%), preferred modality (10%), ease of use (9%), low cost 8%), improved communication (8%) and decreased travel time (7%), which in total accounted for 61% of occurrences. Conclusion This review identified a variety of factors of association between telehealth and patient satisfaction. Knowledge of these factors could help implementers to match interventions as solutions to specific problems.

Evidence of greater health care needs among older veterans of the Vietnam War.

This study examined self-rated health, impairments in activities of daily living, and treatment for eight health conditions among Vietnam War-era veterans, comparing those who served in Vietnam with those who served elsewhere. Data were from the nationally representative 2001 National Survey of Veterans (N = 7,907; 3,923 veterans served in Vietnam). Age-stratified (<60 years versus > or =60 years) analyses included multivariate logistic regression. In adjusted analyses, among those <60 years of age, those who served in Vietnam had notably poorer self-rated health and higher stroke risk (odds ratio, 1.51; 95% confidence interval, 1.48-1.53); odds of most other conditions were lower. Among those > or =60 years of age, those who served in Vietnam had poorer self-rated health, higher cancer risk (odds ratio, 1.33; 95% confidence interval, 1.32-1.35), and more treatment for hypertension, lung conditions, stroke, and hearing loss. Results suggest greater resource use among older veterans who served in Vietnam. Clinicians and the Department of Veterans Affairs should especially note their substantially higher cancer risk.

A Comparison of Disabled Veteran and Nonveteran Income Time to Revise the Law

This study evaluates disabled veteran compensation law against its stated objective, equalizing the pay differential associated with disability. The significance of this study is that it provides insight into the efficacy of disabled veteran compensation policy, which derives from tables listed in the Code of Federal Regulations (38 CFR 4). In some cases, these tables have not been updated since 1945. Through regression analysis, personal income (appropriately transformed) is modeled as a function of four variable blocks (demographics, education, geographical, and veteran-related) using secondary data from the 2007 American Community Survey. The population includes working-age adults ages 18 to 64 (n = 1.8 million, representing N = 190 million U.S. citizens). Regression captured 37.2% of the variance in personal income. Veteran-related variables (entered last into the model) accounted for 2.2% of the unique variance. The sample size guaranteed statistical significance, but the analysis proved practically relevant. Disabled veteran status had a large and negative effect, especially as the number of disabilities increased. The results suggest that disabled veterans who have multiple categories of disabilities do not receive income on par with society or with disabled nonveterans reporting the same number of disabilities. This finding provides evidence that 38 CFR 4 is ineffective.

Evaluating barriers to adopting Telemedicine worldwide: A systematic review

Introduction and objective Studies on telemedicine have shown success in reducing the geographical and time obstacles incurred in the receipt of care in traditional modalities with the same or greater effectiveness; however, there are several barriers that need to be addressed in order for telemedicine technology to spread. The aim of this review is to evaluate barriers to adopting telemedicine worldwide through the analysis of published work. Methods The authors conducted a systematic literature review by extracting the data from the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PubMed (MEDLINE) research databases. The reviewers in this study analysed 30 articles (nine from CINAHL and 21 from Medline) and identified barriers found in the literature. This review followed the checklist from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009. The reviewers organized the results into one table and five figures that depict the data in different ways, organized by: barrier, country-specific barriers, organization-specific barriers, patient-specific barriers, and medical-staff and programmer-specific barriers. Results The reviewers identified 33 barriers with a frequency of 100 occurrences through the 30 articles. The study identified the issues with technically challenged staff (11%), followed by resistance to change (8%), cost (8%), reimbursement (5%), age of patient (5%), and level of education of patient (5%). All other barriers occurred at or less than 4% of the time. Discussion and conclusions Telemedicine is not yet ubiquitous, and barriers vary widely. The top barriers are technology-specific and could be overcome through training, change-management techniques, and alternating delivery by telemedicine and personal patient-to-provider interaction. The results of this study identify several barriers that could be eliminated by focused policy. Future work should evaluate policy to identify which one to lever to maximize the results.

Evidence of poorer life-course mental health outcomes among veterans of the Korean War cohort

Objective: Comparing the outcomes of veterans who served in Korea and those who served elsewhere, we examined the treatment of post-traumatic stress disorder (PTSD), other mental health conditions, psychiatric treatment locations, and six mental health well-being measures. Methods: The analytic sample consisted of nationally representative data from the 2001 National Survey of Veterans (NSV). Analyses included multiple logistic regressions that controlled for sociodemographic characteristics. Results: Korean era veterans in the NSV (n = 4030): 1498 served in Korea; 2532 elsewhere during the era. Veterans who served in Korea have notably poorer mental health than those who served elsewhere. Conclusion: These results suggest higher resource needs among aging Korean era veterans. Clinicians, policy makers and the Department of Veterans Affairs should focus on mental health services to older veterans.

The effectiveness of telemedicine in the management of chronic heart disease – a systematic review:

Objective The primary objective of this systematic review is to assess the effectiveness of telemedicine in managing chronic heart disease patients concerning improvement in varied health attributes. Design This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. Setting We adopted a logical search process used in two main research databases, the Cumulative Index to Nursing and Allied Health Literature and PubMed (MEDLINE). Four reviewers meticulously screened 151 abstracts to determine relevancy and significance to our research objectives. The final sample in the literature review consisted of 20 articles. Main outcome measures We looked for improved medical outcomes as the main outcome measure. Results Our results indicated that telemedicine is highly associated with the reduction in hospitalisations and readmissions (9 of 20 articles, 45%). The other significant attributes most commonly encountered were improved mortality and cost-effectiveness (both 40%) and improved health outcomes (35%). Patient satisfaction occurred the least in the literature, mentioned in only 2 of 20 articles (10%). There was no significant mention of an increase in patient satisfaction because of telemedicine. Conclusions We concluded that telemedicine is considered to be effective in quality measures such as readmissions, moderately effective in health outcomes, only marginally effective in customer satisfaction. Telemedicine shows promise on an alternative modality of care for cardiovascular disease, but additional exploration should continue to quantify the quality measures.

Patient Satisfaction as a Function of In-House Versus Contract Staffing Models in Veterans Affairs Community-Based Outpatient Clinics

As part of decision support for Central Arkansas Veterans Healthcare System, this research evaluated patient satisfaction differences associated with contract versus Veterans Affairs (VA) staffing of community-based outpatient clinics (CBOCs). The research question was as follows: What differences exist between contract versus VA-staffed outpatient clinics in the areas of patient perceptions of access, continuity of care, courtesy, education and information, emotional support, overall coordination, visit coordination, and patient preferences? The quarterly Survey of Healthcare Experiences of Patients provided satisfaction data necessary for this study. Results of Bonferonni-corrected z-tests of proportions indicated that the VA-staffed CBOCs had statistically higher scores for continuity of care, education and information, emotional support, overall coordination, and patient preferences. No statistically significant difference emerged for patient perception of access, courtesy, and visit coordination. The lack of finding associated with visit coordination coupled with the statistically significant difference for overall coordination suggests that coordination for non-VA-staffed CBOCs erodes after the patient encounter. In toto, patients reported higher satisfaction with in-house staffing solutions versus contractor solutions. The authors recommend additional cost-utility research to identify which of the two models, VA-staffed or non-VA-staffed, best meets the needs of all stakeholders.

Optimizing Army Medical Department Officer Accessions

In support of the United States Army Medical Department Personnel Proponency Directorate (APPD), the authors developed a set of math programming models that optimize accessions (hires) for each of the 89 unique active duty officer specialties (e.g., neurosurgeons, aeromedical evacuation pilots, surgical nurses) within six separate corps (e.g., Nurse Corps, Medical Corps, Medical Specialist Corps) encompassing approximately 15,000 Army Medical Department officers. The significance of this set of programming models is that the models provide a decision support mechanism for determining how many officers of each grade to recruit and hire for each specialty. The Medical Specialist Corps model is explicated in this study.

An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: a systematic review

Objectives The main objective was to investigate the applicability and effectiveness of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility (SNF)-to-hospital readmissions. Problem The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. Setting The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature and PubMed to collect data about quality improvement implemented in SNFs. Results The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. Conclusion These strategy examples can be useful to acute care hospitals attempting to lower bounce back from subacute care providers and long-term care facilities seeking quality improvement initiatives to reduce hospital readmissions.

Factors influencing the adoption of telemedicine for treatment of military veterans with post-traumatic stress disorder

BACKGROUND Military veterans returning from a combat zone often face mental health challenges as a result of traumatic experiences. The veteran in the United States has been underdiagnosed and underserved. Since its advancement in the 1990s, telemedicine has become a more prevalent means of delivering services for post-traumatic stress disorder among veterans in the United States, but its adoption is not ubiquitous. OBJECTIVE To clarify the association of telemedicine and the treatment of veterans with post-traumatic stress disorder through identification of facilitators and barriers to the adoption of the modality. METHODS Reviewers analysed articles from CINAHL and PubMed databases, using relative key words, selecting the 28 most germane to the study objective. RESULTS The most common adoption facilitators were: improving access to rural populations of veterans (22%), effective treatment outcomes (16%), and decreased costs related to care (13%). The most prevalent barriers were: veterans lacking access to necessary modalities (25%), availability of physicians competent in post-traumatic stress disorder treatment (20%), and complications with technology (20%). Five themes surfaced for facilitators: accessibility, effectiveness, cost reduction, positive patient perception, and supportive community; and 5 themes for barriers: access to technology, technical complications, physician availability, negative patient perception, and uninformed patients. CONCLUSION This literature review identifies cost and outcomes-effectiveness. The association of telemedicine with the treatment of veterans with post-traumatic stress disorder is feasible, beneficial and effective.