Purpose: VA Office of Rural Health (ORH) Strategic Plan seeks to improve access and quality of care delivered to rural and highly rural veterans by using health information technologies—like the existing video teleconferencing (V-TEL) technology—at the Michael E. DeBakey VAMC and its CBOCs. The main objectives are (1) improve access and quality of care for cancer patients through telemedicine; (2) increase cancer care education for patients and families through use of ancillary services like social work, nutrition, and support groups; and (3) increase use of available and emerging health information technologies for cost savings.
Methods: This program was supported by grant funding obtained from the ORH from 2011 through 2014. The model of the clinic is based on a V-TEL in Houston, the location of the subspecialty and ancillary care provider, while the veteran receives care for hematology and oncology services at the CBOC. The virtual clinics include (1) Patient Care and Education Clinic for chemotherapy education and provider education: This includes new patient clinics as well as surveillance clinics; (2) Supportive Care: This includes nutrition education and palliative care, and symptom management. (3) Psychosocial: This includes support groups, mental health assessments, and a social worker clinic. Internal Review Board approval was obtained for maintenance of an access database as well as to administer surveys to obtain patient satisfaction scores. Details about demographics, clinic use, and services provided are maintained in the access database.
Results: There have been 2,116 encounters performed to date via the V-TEL clinics serving 1,162 unique veterans for their hematology and oncology subspecialty care, including 819 veterans from rural areas. The clinics have been successful for multidisciplinary delivery of multiple ancillary services as well, with 935 visits for patient education, 673 encounters for psychosocial care, and 262 visits for nutrition education in combination with patient care visits. Patient satisfaction ratings have been extremely high, with mean scores of over 4.7/5 for the overall program. Over $350,000 in travel costs have been saved. An analysis of the difference in the bed days of care (BDOC) among rural/CBOC veterans getting V-TEL (4.45 days) vs those not getting V-TEL (7.45 days) showed that the difference was significant (P = .01) and indicates that the V-TEL program has the potential to improve health care specific outcomes.
Conclusions: We have achieved our goal of improving care of veterans with cancer and blood disorders by enabling easier access to care through our V-TEL program. We have been able to use our experience in mentoring other programs and incorporating more disciplines into our care, such as mental health and genetic counseling for cancer patients, and plan to expand to survivorship care. Though this cannot be used to replace in-person visits, using V-TEL as an adjunct to care improves veteran education, monitoring, and health outcomes. Veterans are highly satisfied with this method of care delivery.
