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Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study

BACKGROUND: Telehealth has potential to help individuals in rural areas overcome geographical barriers and to improve access to care. The factors that influence the implementation and use of telehealth in critical access hospitals are in need of exploration. OBJECTIVE: The aim of this study is to un...

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Autores principales: Haque, Saira Naim, DeStefano, Sydney, Banger, Alison, Rutledge, Regina, Romaire, Melissa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135026/
https://www.ncbi.nlm.nih.gov/pubmed/33949958
http://dx.doi.org/10.2196/24118
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author Haque, Saira Naim
DeStefano, Sydney
Banger, Alison
Rutledge, Regina
Romaire, Melissa
author_facet Haque, Saira Naim
DeStefano, Sydney
Banger, Alison
Rutledge, Regina
Romaire, Melissa
author_sort Haque, Saira Naim
collection PubMed
description BACKGROUND: Telehealth has potential to help individuals in rural areas overcome geographical barriers and to improve access to care. The factors that influence the implementation and use of telehealth in critical access hospitals are in need of exploration. OBJECTIVE: The aim of this study is to understand the factors that influenced telehealth uptake and use in a set of frontier critical access hospitals in the United States. METHODS: This work was conducted as part of a larger evaluation of a Centers for Medicare & Medicaid Services–funded demonstration program to expand cost-based reimbursement for services for Medicare beneficiaries for frontier critical access hospitals. Our sample was 8 critical access hospitals in Montana, Nevada, and North Dakota that implemented the telehealth aspect of that demonstration. We reviewed applications and progress reports for the demonstration program and conducted in-person site visits. We used a semistructured discussion guide to facilitate conversations with clinical, administrative, and information technology staff. Using NVivo software (QSR International), we coded the notes from the interviews and then analyzed the themes. RESULTS: Several factors influenced the implementation and use of telehealth in critical access hospitals, including making changes to workflow and infrastructure as well as practitioner acceptance and availability. Participants also cited technical assistance and support for implementation as supportive factors. CONCLUSIONS: Frontier critical access hospitals may adopt telehealth to overcome challenges such as distance from specialty practitioners and workforce challenges. Telehealth can be used for provider-to-patient and provider-to-provider interactions to improve access to care, remove barriers, and improve quality. However, the ability of telehealth to improve outcomes is limited by factors such as workflow and infrastructure changes, practitioner acceptance and availability, and financing.
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spelling pubmed-81350262021-05-24 Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study Haque, Saira Naim DeStefano, Sydney Banger, Alison Rutledge, Regina Romaire, Melissa JMIR Form Res Original Paper BACKGROUND: Telehealth has potential to help individuals in rural areas overcome geographical barriers and to improve access to care. The factors that influence the implementation and use of telehealth in critical access hospitals are in need of exploration. OBJECTIVE: The aim of this study is to understand the factors that influenced telehealth uptake and use in a set of frontier critical access hospitals in the United States. METHODS: This work was conducted as part of a larger evaluation of a Centers for Medicare & Medicaid Services–funded demonstration program to expand cost-based reimbursement for services for Medicare beneficiaries for frontier critical access hospitals. Our sample was 8 critical access hospitals in Montana, Nevada, and North Dakota that implemented the telehealth aspect of that demonstration. We reviewed applications and progress reports for the demonstration program and conducted in-person site visits. We used a semistructured discussion guide to facilitate conversations with clinical, administrative, and information technology staff. Using NVivo software (QSR International), we coded the notes from the interviews and then analyzed the themes. RESULTS: Several factors influenced the implementation and use of telehealth in critical access hospitals, including making changes to workflow and infrastructure as well as practitioner acceptance and availability. Participants also cited technical assistance and support for implementation as supportive factors. CONCLUSIONS: Frontier critical access hospitals may adopt telehealth to overcome challenges such as distance from specialty practitioners and workforce challenges. Telehealth can be used for provider-to-patient and provider-to-provider interactions to improve access to care, remove barriers, and improve quality. However, the ability of telehealth to improve outcomes is limited by factors such as workflow and infrastructure changes, practitioner acceptance and availability, and financing. JMIR Publications 2021-05-05 /pmc/articles/PMC8135026/ /pubmed/33949958 http://dx.doi.org/10.2196/24118 Text en ©Saira Naim Haque, Sydney DeStefano, Alison Banger, Regina Rutledge, Melissa Romaire. Originally published in JMIR Formative Research (https://formative.jmir.org), 05.05.2021. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.
spellingShingle Original Paper
Haque, Saira Naim
DeStefano, Sydney
Banger, Alison
Rutledge, Regina
Romaire, Melissa
Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study
title Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study
title_full Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study
title_fullStr Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study
title_full_unstemmed Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study
title_short Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study
title_sort factors influencing telehealth implementation and use in frontier critical access hospitals: qualitative study
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135026/
https://www.ncbi.nlm.nih.gov/pubmed/33949958
http://dx.doi.org/10.2196/24118
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