| Study summary: |
|
Spinal cord injury and disorders (SCI/D) is the most costly medical condition in VA and
pressure ulcers (PrUs) are a major source of morbidity and mortality and decreased quality
of life in the SCI/D population, accounting for about 1/3 of all VA SCI admissions. PrUs
are a serious, costly, and life-long complication of SCI/D due to lack of sensation and
immobility. Promoting prevention and early detection/reporting of PrUs in the
community-dwelling SCI/D population are important goals for VA.
VHA has promoted monitoring patients' self-care and non-institutional care needs using
in-home messaging devices with disease management protocols (DMPs) to reduce unnecessary
duplication in healthcare costs and/or to improve quality of life for individuals with
chronic disease conditions by preventing/minimizing the effects of a disease through care
coordination. No such DMPs exist for the SCI/D population. Our study objective is to
develop the tools for implementing a new home telehealth program to manage
community-dwelling veterans with SCI/D at high risk of developing PrUs. Specific objectives
of the study include: 1) Using an expert panel to validate PrU DMP items, recommending item
frequency, prioritizing items (high/medium/low), specifying clinical responses to items; 2)
Developing a draft of a standardized protocol relevant to the participating hub and spoke
sites for the nurse Care Coordinator to manage patients who develop open skin wounds; 3)
Assessing individual telehealth DMP items by calling a sample of patients on a daily or
weekly basis for up to 2 months to determine their validity and 4) Using information from
the provider interviews to develop an instrument to assess staff satisfaction with this
method of patient management.
A convenience sample of veterans discharged from the Cleveland SCI/D inpatient unit
(including patients from the Cleveland SCI Center spoke sites) will be asked to participate
in a validation study of the PrU DMP items. Subjects will be randomly assigned to receive
either daily (M-F) or weekly calls and asked to respond to the dialogue questions for 2
months. Patients will be stratified according to their risk of developing PrUs, using the
Braden Risk Assessment tool. Up to 50 patients will be enrolled over a 2 month period.
Interviews will be conducted with patients on a daily or weekly basis, at baseline and the
end of study. Patient knowledge, use of self-management strategies and behaviors and
satisfaction with the program will be assessed at baseline and 2 months post-discharge.
Clinical information, including Braden PrU risk data, nutritional assessment, etc., will be
obtained from the electronic medical record. We will also obtain the following information
from patients if they experience skin breakdown: wound photos, follow-up with primary care
provider at spokes site about further treatment, size, color, dressings/treatment details.
The practical impact of this research will be to develop, evaluate and validate the home
telehealth DMP items to help patients manage/prevent skin breakdown.
VHA has been a leader in the use of distance technology to monitor patients' self-care and
non-institutional care needs using an in-home messaging device with disease management
protocols (DMPs). This strategy has been used extensively in VA as a method of reducing
unnecessary duplication in healthcare costs and/or to improve quality of life for
individuals with chronic disease conditions by preventing or minimizing the effects of a
disease through care coordination. No such DMPs exist for the SCI/D population. Thus our
overall objective for this study is to develop the tools necessary for implementing a new
home telehealth program to manage community-dwelling veterans with SCI/D at high risk of
developing PrUs. Specific objectives of the study include: 1) Convening an expert panel to
validate PrU DMP items, to recommend the frequency for asking specific items, to classify
items into high/medium/low priority, and to specify nurse responses to items (based on item
priority classification); 2) Developing a draft of a standardized protocol relevant to the
participating hub and spoke sites for the nurse Care Coordinator to manage patients who
develop open skin wounds; 3) Assessing individual telehealth DMP items by calling a sample
of patients on a daily or weekly basis for up to 2 months to determine their validity and 4)
Using information from the provider interviews to develop an instrument to assess staff
satisfaction with this method of patient management.
A convenience sample of veterans discharged from the Cleveland SCI/D inpatient unit
(including patients from the Cleveland SCI Center spoke sites) will be asked to participate
in a validation study of the PrU DPM items. Subjects will be randomly assigned to receive
either daily (M-F) or weekly calls and asked to respond to the dialogue questions for 2
months. Patients will be stratified according to their risk of developing PrUs, using the
Braden Risk Assessment tool. UP to 50 patients will be enrolled over a 2 month period.
Interviews will be conducted with patients on a daily or weekly basis, at baseline and the
end of study. Patient knowledge, use of self-management strategies and behaviors and
satisfaction with the program will be assessed at baseline and 2 months post-discharge.
Clinical information, including Braden PrU risk data, nutritional assessment, etc., will be
obtained from the electronic medical record. We will also obtain the following information
from patients if they experience skin breakdown: wound photos, follow-up with primary care
provider at spokes site about further treatment, size, color, dressings/treatment details.
The practical impact of this research will be to develop, evaluate and validate the home
telehealth DMP items to help patients manage/prevent skin breakdown. |