Journal of Telemedicine and Telecare最新文献

{"title":"In-person versus telehealth video: A retrospective audit of medication prescriptions, orders, and patient instructions in ambulatory nephrology care.","authors":"Kevin Shi, Laura Plantinga, Aris Oates, Lowell Lo, Delphine Tuot","doi":"10.1177/1357633X261469667","DOIUrl":"https://doi.org/10.1177/1357633X261469667","url":null,"abstract":"<p><p>IntroductionThe COVID-19 pandemic greatly expanded the use of telehealth in nephrology, and telehealth remains a popular modality for kidney care. However, there are no consensus guidelines on the implementation of telehealth in ambulatory nephrology care. To examine this field further, we examined the association between clinic encounter modality (in-person versus telehealth) with provider actions to advance patient care plans in one academic nephrology practice.MethodsElectronic health records from 26,170 telehealth video and 11,558 in-person encounters from January 2020 to December 2024 were analyzed. Mixed effects models were used to assess the association between encounter modality and medication prescription change rates, order rates, and patient instruction documentation frequency.ResultsCompared to in-person encounters, telehealth video visits served patients of younger age (60.4 years (SD = 18.1) vs. 66.7 (17.4), <i>p</i> < 0.001) and with less severe kidney disease (estimated glomerular filtration rate 51.9 ml/min/1.73 m² (SD = 30.2) vs. 46.1 ml/min/1.73 m² (26.6), <i>p</i> < 0.001). Accounting for encounter, patient, and provider characteristics, telehealth modality was independently associated with 23% fewer medication prescription changes (incidence rate ratio (IRR) = 0.77, 95% CI 0.74-0.80), 38% fewer orders (IRR = 0.62, 95% CI 0.57-0.68), and 84% lower odds of patient instructions documentation (odds ratio = 0.16, 95% CI 0.09-0.31) compared with in-person encounters.ConclusionThese data suggest that providers use telehealth video and in-person encounters to advance patient care plans differently. Acknowledging these differences will be crucial to establish best practices for telehealth utilization in ambulatory nephrology care and assure ongoing high-quality care delivery.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"1357633X261469667"},"PeriodicalIF":3.3,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparable times to lung cancer diagnosis with virtual and in-person care: An observational study during the COVID-19 pandemic.","authors":"Chandak Upagupta, Jordan N Sugarman, Harvey H Wong, Lee M Fidler, Jason Rajchgot, Christine M McDonald","doi":"10.1177/1357633X261463832","DOIUrl":"https://doi.org/10.1177/1357633X261463832","url":null,"abstract":"<p><p>IntroductionTimely diagnosis of lung cancer is critical for improving health outcomes. During the COVID-19 pandemic, the use of virtual healthcare increased to facilitate distancing, accessibility and convenience. Despite these perceived benefits, the impact of virtual care on timeliness and quality within the lung cancer diagnostic pathway remains unclear.ObjectiveTo evaluate differences in time to lung cancer diagnosis and health outcomes between virtual and in-person care models.MethodsWe conducted a retrospective cohort study of all patients referred to a Lung Diagnostic Assessment Program (LDAP) at a large academic hospital in Ontario, Canada in 2022. Patients were grouped based on whether their intake visit was conducted virtually or in-person. The primary outcome was time from referral to tissue diagnosis. Secondary outcomes include time from referral to initial consultation and biopsy, time to complete all investigations, hospitalizations, cancelled procedures and death during the diagnostic interval. Outcomes were compared between groups.ResultsAcross 265 clinical encounters (120 virtual, 145 in-person) the median time from referral to tissue diagnosis was 28.5 days [IQR = 18-45] for virtual and 28 days [IQR = 20-51] for in-person care (<i>p = .</i>55). Times to consultation, diagnostic biopsy and completion of diagnostic testing were similar between groups. Hospitalizations, procedure cancellation, and mortality did not differ between care delivery models.DiscussionVirtual care demonstrated timeliness and health outcomes comparable to in-person care, supporting its role as a feasible alternative in the lung cancer diagnostic pathway.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"1357633X261463832"},"PeriodicalIF":3.3,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National study to characterize teletrauma use in United States emergency departments.","authors":"Zain G Hashmi, Janice A Espinola, Ashley F Sullivan, Krislyn M Boggs, Maeve Swanton, Russell Griffin, Jan O Jansen, Jeffrey D Kerby, Carlos A Camargo","doi":"10.1177/1357633X261462011","DOIUrl":"https://doi.org/10.1177/1357633X261462011","url":null,"abstract":"<p><p>BackgroundEmergency department (ED)-based teletrauma service may improve access to trauma expertise, especially in rural areas. However, its impact on patient outcomes remains unclear due to limited understanding of how and what type of care is delivered. The objective of this study was to characterize how EDs in the United States (US) use teletrauma services in clinical practice.MethodsNon-federal/non-specialty EDs, that previously reported using teletrauma, were surveyed in the 2023 National Emergency Department Inventory Teletrauma Survey. The survey was developed and mailed/emailed to ED directors up to two times; nonresponders were contacted via telephone. Survey assessed structural and process measures including staffing, workflows, clinical care, and resource availability. Descriptive statistics were used.ResultsAmong 378 EDs that reported using teletrauma in 2022, 310 responded (82%). Only 68% (211/310) reported using teletrauma in 2023. Most teletrauma-using EDs (TT-EDs) used the service once a month or less (58%), were staffed by non-emergency medicine (EM)-trained providers for in-person care (69%) and EM-trained physicians for remote care (72%). Consults were usually initiated at the discretion of the in-person provider (80%) and often after the patient's arrival to the ED (46%). Clinical applications included decision-support for interfacility transfers (78%), resuscitation-support (71%), documentation (69%) and remote procedural-support (64%) for patients of all ages. Some TT-EDs received trauma education from teletrauma-providing sites (30%), but few reported receiving resources, such as blood products (4%).ConclusionTeletrauma is not widely used in US EDs. Even when capabilities exist, teletrauma use remains limited and insufficiently adapted to rural trauma care.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"1357633X261462011"},"PeriodicalIF":3.3,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual care for chronic wounds in residential aged care settings: A scoping review.","authors":"Heather Russell, Georgina Luscombe, Annie Banbury, Meredith Makeham, Michelle Barakat-Johnson","doi":"10.1177/1357633X261462025","DOIUrl":"https://doi.org/10.1177/1357633X261462025","url":null,"abstract":"<p><p>IntroductionChronic wounds which do not heal as expected, are common in residential aged care homes (RACHs). While specialised wound care is essential for improving outcomes, access is challenging in RACHs. Emerging virtual interventions are known to improve access to wound care, but little is known about use in this setting. This scoping review identifies and maps virtual wound care use in RACHs.MethodsAn electronic search of Medline, CINAHL, Embase, AgeLine, IEEE Xplore, ACM digital library and clinical trial registries was conducted from database inception to March 2026. Studies were screened and data extracted by two independent reviewers using a reviewer-developed tool.ResultsOf the 17 included studies, a combined model of telehealth and store and forward was most frequently used (n = 9). Virtual wound care was used for both diagnosis and management (n = 15) and commonly delivered by teams of clinicians (n = 8). Included studies demonstrated wound care could be delivered safely and facilitated clinical decision-making. Acceptability of virtual wound care by residents, families, staff and other care providers was high. Reliable internet, stable workforce and adjunct in-person care were enablers to virtual interventions. Lack of training participation, workforce shortages and technology limitations were perceived barriers to virtual wound care.ConclusionsCurrent evidence indicates that virtual wound care is being used in RACHs though it remains under investigated. Addressing workforce, training, and technology barriers can support broader implementation of virtual wound care and improve chronic wound outcomes for aged care residents.Review registrationOpen Science Framework https://osf.io/j97bt.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"1357633X261462025"},"PeriodicalIF":3.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of patient-led melanoma surveillance and teledermatology in underserved groups in the Melanoma Self-Surveillance Trial: A qualitative sub-study.","authors":"Priti Kharel, Ellie Medcalf, Deonna Ackermann, Jake Williams, Jolyn Hersch, Zhuohan Wu, Monika Janda, Dorothy Drabarek, Adrian Fann, Katy Bell","doi":"10.1177/1357633X261457782","DOIUrl":"https://doi.org/10.1177/1357633X261457782","url":null,"abstract":"<p><p>BackgroundPatient-led melanoma surveillance using mobile dermoscopy and teledermatology may support earlier detection and improve access to dermatology care for underserved populations.MethodsWe conducted semi-structured interviews with Melanoma Self Surveillance (MEL-SELF) Trial participants (control, intervention and run-in participants) to explore ways to support mobile teledermatology uptake among underserved populations. Participants had 1+ underserved population characteristics: age ≥70 years, residence outside major cities, low income, and Aboriginal and/or Torres Strait Islander (First Nations Australians) identity. We used thematic analysis to code data and report findings.ResultsOf the 22 participants (55% women; mean age 64.7 years), nine were ≥70 years, 13 lived outside major cities, four had low income and two identified as First Nations Australians (six had ≥2 characteristics). Participants valued the convenience of home-based skin checks, reassurance from expert feedback delivered via teledermatology and increased access to dermatology care. Family or partner support helped participants use the technology and examine hard-to-see areas, which increased confidence and adherence to the intervention. Barriers to skin self-examination included physical limitations, low confidence, and difficulties using the app or dermatoscope. Regional participants noted that teledermatology could potentially help reduce travel costs, provided additional clinic visits were not prompted by the teledermatology. Participants suggested that clear instructions and face-to-face training would facilitate uptake in practice, and that help from health professionals may also be beneficial.ConclusionTailored instructions, training, and technical assistance may help underserved groups use patient-led melanoma surveillance and improve their access to dermatological care.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"1357633X261457782"},"PeriodicalIF":3.3,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of the validity and reliability of tele-assessment of upper extremity functions in individuals with stroke.","authors":"Lamia Nur Hamaşoğlu, Esra Doğru-Hüzmeli, Arzu Dinç-Yavaş, Tuğba Çalışır, Taşkın Duman, Nilüfer Çetişli-Korkmaz","doi":"10.1177/1357633X261463833","DOIUrl":"https://doi.org/10.1177/1357633X261463833","url":null,"abstract":"<p><p>ObjectiveThis study aimed to investigate the validity and reliability of assessment tools used to evaluate upper extremity function in individuals with stroke using a tele-assessment approach.MethodsTwenty-four individuals with stroke (mean age: 61.13 ± 12.56 years), aged 18-75 years and classified as Brunnstrom stage ≥3 for upper extremity and hand function, were included. Upper extremity function was assessed using the Motor Activity Log-28 (MAL-28), Duruöz Hand Index (DHI), ABILHAND-Stroke Hand Function Questionnaire (ASQ), Nine-Hole Peg Test (NHPT), and Fugl-Meyer Upper Extremity Motor Assessment (FM-UE) using face-to-face and tele-assessment. Tele-assessment sessions were video-recorded and re-evaluated by the same physiotherapist after 3 weeks.ResultsThe NHPT completion times for the non-affected hand were significantly longer during tele-assessment than during the face-to-face assessment (<i>p</i> < 0.001). Agreement among face-to-face assessment, tele-assessment, and repeated tele-assessment was good for DHI dressing, NHPT non-affected hand, and FM-UE coordination and speed subscales (intra-class correlation coefficient (ICC) = 0.80-0.90), while all other measures showed excellent agreement (ICC > 0.90). Intra-rater reliability between tele-assessment and repeated tele-assessment was good for the FM-UE coordination and speed subscales (ICC = 0.834) and excellent for all remaining measures. The affected side (right/left) did not significantly influence tele-assessment outcomes (<i>p</i> > 0.05).ConclusionThe MAL-28, DHI, ASQ, NHPT, and FM-UE can be administered reliably via tele-assessment to evaluate upper extremity function in individuals with stroke. Tele-assessment represents a valid and reliable alternative for functional evaluations that can be conducted verbally and do not require physical guidance, particularly for individuals with limited access to healthcare services.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"1357633X261463833"},"PeriodicalIF":3.3,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing validity and costs of virtual diagnostics for sleep disorders: A feasibility study.","authors":"Christoph P Beier, Anne Mette Ølholm, Gonçalo Nuno Bastos Dos Reis Morais, Ann Christine Waarkjær Olsen, Kristian Kidholm","doi":"10.1177/1357633X251372678","DOIUrl":"10.1177/1357633X251372678","url":null,"abstract":"<p><p>IntroductionThe use of digital solutions including patient-reported outcomes is limited to follow-up of patients with established diagnoses but is rarely used as first step of the diagnostic process substituting a personal contact with a health professional. We report on the diagnostic validity and cost per patient implications based on a feasibility study of a new virtual diagnostic service (VDS) for common neurological sleep disorders that, as a first step, involves the collection and automated analysis of self-reported digital patient data.MethodsThe VDS was established at the Odense University Hospital, Denmark. Assessment of diagnostic validity of the underlying algorithm was conducted independently and blinded. Estimation of effects on cost per patient was based on administrative hospital cost data comparing similar periods before and after the introduction of VDS and estimates for travel and time consumption to assess the patients' economic benefits.ResultsA questionnaire-based algorithm was developed leveraging the diagnostic criteria of the American Academy of Sleep Medicine; comprehensibility was secured and improved by initial patient involvement. Parallel use of both the questionnaire and assessment by a senior sleep specialist of the first 20 patients revealed no discernible safety concerns and resulted in additional linguistic adaptions. The final questionnaire was completed by 123 of 157 patients (78.3%) identified as suitable for VDS. The questionnaire-based algorithm resulted in correct use of additional diagnostic procedures in 84 out of 95 patients with final diagnosis at data closure (88.4%, Cohen's kappa: 0.84). The algorithm proposed a specific diagnosis in 55 patients that was correct in 49.1% of cases (Cohen's kappa: 0.39). The economic analysis revealed a 46.7% reduction of the time from referral to diagnosis of the patient (226.5 days to 120.7 days). The average number of contacts with health professionals decreased from 2.15 to 1.26, the average direct costs per patients were reduced by 39.6% from 1811 Danish Kroner (DKK) to 1093 DKK. We estimated a 40.6% reduction of the total costs per patients from 3904 DKK to 2320 DKK including time consumption and travel costs.DiscussionThis first feasibility study indicates that use of digital diagnostic solutions as first step of the diagnostic process of neurological sleep disorders combined with an essentially complete virtual work flow has high accuracy and may be associated with reduced time for diagnostics and cost reductions for health providers and patients.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"532-541"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telehealth-directed emergency tube thoracostomy.","authors":"Ben Aston, Benjamin Powell","doi":"10.1177/1357633X251372248","DOIUrl":"10.1177/1357633X251372248","url":null,"abstract":"<p><p>In this case, we describe the remote telehealth leadership of emergent tube thoracostomy in a patient with a critical respiratory status. The patient had presented to a small rural health care facility with breathlessness and hypoxia despite supplemental oxygen. A subsequent chest x-ray revealed a large pneumothorax requiring emergent treatment to prevent respiratory demise. Due to their location, the arrival of a critical care team would be delayed, and the local staff had very limited prior experience with chest procedures. Through remote telehealth leadership, the local team was guided through initial attempts at the Seldinger tube thoracostomy technique, before progressing to an open approach following failure of the initial attempt. Ultimately, the patient was stabilised and remained admitted locally, avoiding aeromedical retrieval. Key learnings included the need to develop a shared mental model of the procedure, responding to local equipment limitations, the leadership response to initial technique failure, and maintenance of situational awareness. This furthers evidence provided in prior case reports that high acuity low occurrence critical care procedures can be facilitated via remote telehealth support.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"560-563"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Video triage by emergency medical service secondary triage clinicians in Victoria, Australia.","authors":"Emily Nehme, Charlotte Flaus, Scott Clarke, Nicole Magnuson, Diana Zimmermann, Peter Cameron, Ziad Nehme, Karen Smith","doi":"10.1177/1357633X251383395","DOIUrl":"10.1177/1357633X251383395","url":null,"abstract":"<p><p>BackgroundUse of video triage in emergency medical dispatch centres is novel. We describe the impact of a video triage trial on call outcomes, triage accuracy and recontact with the emergency medical service in Victoria, Australia.MethodsA retrospective observational study of consecutive low to medium-acuity emergency ambulance calls undergoing secondary triage between 27/11/2023 and 17/03/2024. Propensity matching was performed to match video triage patients with traditional telephone triage patients.ResultsVideo triage patients were younger than telephone triage patients (49.1 vs. 59.2 years), and more frequently called in-hours (49.5% vs. 39.0%) for injuries or wounds (24.8% vs. 9.1%). Propensity matching yielded 1036 matched pairs. In the matched population, video triage was associated with reduced odds of emergency ambulance dispatch (odds ratio [OR] = 0.621 [95% confidence interval [CI] 0.521,0.741]) and increased odds of referral to alternate health services (OR = 1.287 [95%CI 1.032,1.605]). The odds of recontact within 24 hours among patients referred to alternate services were halved after video triage (OR = 0.514 [95%CI 0.320,0.826]). The technology was associated with increased alignment between dispatch priority and patient acuity (OR = 1.356 [95%CI 1.019,1.804]), and a reduction in over-triage (OR = 0.695 [95%CI 0.520,0.929]). Although, the overall secondary triage duration was longer when video triage was used (22 vs. 15 minutes, <i>P</i> < 0.001), there was no difference in time to ambulance dispatch for time-critical patients.ConclusionVideo triage by secondary triage clinicians was associated with fewer emergency ambulance dispatches, more referrals to alternate services, fewer recontacts and improved triage accuracy. Expansion of the technology to primary triage warrants exploration.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"542-550"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Same goal, different perspectives: Stakeholder views on context for connected care technology implementation in an integrated healthcare system.","authors":"Stephanie A Robinson, Jessica M Lipschitz, Ndindam Ndiwane, Felicia R Bixler, Bella Etingen, Mark S Zocchi, Stephanie L Shimada, Jennifer A Palmer, Terry J Newton, Nilesh Shah, Timothy P Hogan","doi":"10.1177/1357633X251371113","DOIUrl":"10.1177/1357633X251371113","url":null,"abstract":"<p><p>IntroductionThe Veterans Health Administration (VHA) prioritizes use of connected care technologies to enhance access and outcomes. The context in which connected care is implemented is crucial, yet difficult to measure, due to its subjective and complex nature. This evaluation examined alignment among stakeholder perceptions of context related to connected care implementation across VHA.MethodsA national, cross-sectional survey assessed perceptions of 11 contextual factors relevant to connected care implementation as identified in published reviews within the implementation science literature. Across 142 VHA facilities and 18 regions, surveys were sent to four stakeholder groups: clinical team members, connected care coordinators, facility leadership, and regional leadership. Mean scores for each factor were compared between stakeholder groups using Welch's ANOVA and Bonferroni-corrected post-hoc comparisons.ResultsA total of 5541 respondents (36.1% response rate) participated. Organizational Culture and Climate was rated the most favorable contextual factor (mean = 3.9, SD = 0.7), while Financial Resources was perceived as least favorable (mean = 3.0, SD = 1.0). Significant differences emerged between the perceptions of frontline workers (clinical team members, connected care coordinators) and leadership (facility, regional). Clinical team members rated nearly all contextual factors less favorably than facility leadership. Coordinators similarly rated most factors less favorably than leadership.DiscussionFindings highlight a misalignment between leadership and frontline workers in their perceptions of organizational context for implementing connected care technologies. Leadership viewed key contextual factors (e.g. Organizational Readiness to Change, Leadership Support) more favorably than frontline workers. This misalignment may impact implementation success, suggesting a need for strategies to better align stakeholder perceptions.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"502-510"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12643463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}