JMIR Publications

ABSTRACT

Background:

Chronic wounds (e.g., pressure injuries, diabetic foot ulcers) are a significant predictor of mortality. Veterans who reside in rural areas often have difficulty accessing care for their wounds. TeleWound practice (TWP), a coordinated effort to incorporate telehealth into the provision of specialty care for patients with skin wounds, has the potential to increase access to wound care by allowing Veterans to receive this care at nearby outpatient clinics or in their homes. The Veterans Health Administration (VA) is championing the roll-out of the TWP, starting with regional implementation.

Objective:

VA researchers have partnered with VA national operations program offices to evaluate the TWP implementation process and program outcomes.

Methods:

We are conducting a mixed-methods evaluation of four VA medical centers and their community-based outpatient clinics that are participating in the initial implementation of the TWP. Data will be collected from Veterans, VA health care team members, and other key stakeholders (e.g., clinical leadership). We will utilize qualitative methods (i.e., semi-structured interviews), site visits, and quantitative methods (i.e., surveys, national VA administrative databases) to assess the process and reach of TWP implementation, and its’ impact on Veteran clinical outcomes and travel burden/costs.

Results:

We will use surveys and interviews with Veterans, VA healthcare team members, and other key stakeholders involved in TeleWound implementation and care delivery, to examine each stakeholder’s perspectives regarding barriers and facilitators that influence successful implementation of the TWP. In addition, the planned site visits will allow us to observe the processes and workflow involved in delivering TeleWound care. We will also examine the impact of the TWP on healthcare system outcomes through analyses of VA administrative data.

Conclusions:

Evaluation of the TWP will identify barriers and solutions to TeleWound implementation in a small number of sites that can be used to inform successful roll-out of the TWP nationally. Our evaluation work will inform future efforts to scale-up the TWP across VA and optimize reach of the program to Veterans across the nation.