Evaluating spoke facilitation costs of implementing TelePain in the Veterans Health Administration.

Alexandra L Rose, Shaina Coogan, Jess Indresano, Steven B Zeliadt, Jessica A Chen
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Abstract

Background: The high prevalence and significant morbidity and mortality associated with chronic pain among veterans has made expansion of pain services within the Veterans Health Administration (VHA) a key priority. TelePain, in which services are provided via telehealth from central "hub" sites to patients at decentralized "spoke" sites, is one such model with positive implementation findings to date. However, the staff effort and cost of implementation have yet to be examined when considering TelePain or similar virtual hub-and spoke models of specialty pain care, information that is critical for expansion of services.

Methods: Using an established time-based activity tracker designed for implementation facilitation, study staff tracked minutes spent on implementation activities at 11 spoke sites. Annual salaries were extracted to calculate an average cost per minute for each personnel type. Costs per personnel minute were combined with activity data to calculate costs of implementation activities at spoke sites. Implementation reach outcomes for the first 36 months of implementation were extracted from the electronic health record. Service utilization data was combined with cost data to calculate cost per patient reached and per clinical encounter achieved at each site.

Results: Total facilitation costs (range: $1,746-$7,978) and unique patients reached (range: 2-46) varied considerably across spoke sites and greater staff implementation efforts (measured in time or cost) were not associated with greater numbers of patients reached. Therefore, costs per patient reached also varied widely (range: $120-2,569) across spoke sites. Key challenges included high rurality and small clinic size; insufficient engagement of frontline providers; lack of referral options for high acuity patients; and lack of existing programming within which to situate pain services.

Conclusions: At spoke sites where patients were consistently referred and reached, costs were relatively modest, particularly compared to the high cost of untreated chronic pain, suggesting the potential impact of this model at scale. However, in spoke sites where referrals and encounters were low during initial implementation, cost per patient was high. Findings highlight the need for better methods for tailoring of facilitation interventions to spoke site's individual needs to maximize impact.

评估在退伍军人健康管理局实施远程培训的成本。
背景:退伍军人慢性疼痛的高患病率和显著的发病率和死亡率使得退伍军人健康管理局(VHA)的疼痛服务的扩展成为一个关键的优先事项。TelePain就是这样一种模式,它通过远程保健从中央“枢纽”地点向分散的“spoke”地点的病人提供服务,迄今取得了积极的实施成果。然而,在考虑TelePain或类似的专业疼痛护理虚拟中心和辐射模型时,员工的努力和实施成本尚未得到审查,这些信息对扩展服务至关重要。方法:使用为促进实施而设计的基于时间的活动跟踪器,研究人员在11个spoke站点跟踪实施活动的分钟数。将年薪提取出来,以计算每种人员类型每分钟的平均成本。每人员分钟的费用与活动数据相结合,以计算在发言地点执行活动的费用。从电子健康记录中提取了前36个月的实施成果。服务利用数据与成本数据相结合,计算每个站点达到的每位患者的成本和每次临床就诊的成本。结果:总促进成本(范围:1,746- 7,978美元)和到达的独特患者(范围:2-46美元)在不同的地点差异很大,更大的工作人员实施努力(以时间或成本衡量)与到达的患者数量无关。因此,每个病人的费用在不同的地点也有很大的差异(范围:120- 2569美元)。主要挑战包括高农村性和小诊所规模;一线服务提供者参与不足;缺乏对高敏度患者的转诊选择;以及缺乏现有的程序来定位疼痛服务。结论:在患者持续转诊和到达的地点,成本相对适中,特别是与未经治疗的慢性疼痛的高成本相比,这表明该模型在规模上的潜在影响。然而,在最初实施期间转诊和就诊人数较低的地区,每位患者的费用很高。研究结果强调需要更好的方法来定制促进干预措施,以满足spoke站点的个人需求,以最大限度地发挥影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
4.20
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