Journal article
Delivering fracture prevention services to rural US veterans through telemedicine: a process evaluation
Archives of osteoporosis, Vol.16(1), 27
12/01/2021
DOI: 10.1007/s11657-021-00882-0
PMCID: PMC7875846
PMID: 33566174
Abstract
An informatics-driven population bone health clinic was implemented to identify, screen, and treat rural US Veterans at risk for osteoporosis. We report the results of our implementation process evaluation which demonstrated BHT to be a feasible telehealth model for delivering preventative osteoporosis services in this setting.
An established and growing quality gap in osteoporosis evaluation and treatment of at-risk patients has yet to be met with corresponding clinical care models addressing osteoporosis primary prevention. The rural bone health tea m (BHT) was implemented to identify, screen, and treat rural Veterans lacking evidence of bone health care and we conducted a process evaluation to understand BHT implementation feasibility.
For this evaluation, we defined the primary outcome as the number of Veterans evaluated with DXA and a secondary outcome as the number of Veterans who initiated prescription therapy to reduce fracture risk. Outcomes were measured over a 15-month period and analyzed descriptively. Qualitative data to understand successful implementation were collected concurrently by conducting interviews with clinical personnel interacting with BHT and BHT staff and observations of BHT implementation processes at three site visits using the Promoting Action on Research Implementation in Health Services (PARIHS) framework.
Of 4500 at-risk, rural Veterans offered osteoporosis screening, 1081 (24%) completed screening, and of these, 37% had normal bone density, 48% osteopenia, and 15% osteoporosis. Among Veterans with pharmacotherapy indications, 90% initiated therapy. Qualitative analyses identified barriers of rural geography, rural population characteristics, and the infrastructural resource requirement. Data infrastructure, evidence base for care delivery, stakeholder buy-in, formal and informal facilitator engagement, and focus on teamwork were identified as facilitators of implementation success.
The BHT is a feasible population telehealth model for delivering preventative osteoporosis care to rural Veterans.
Details
- Title: Subtitle
- Delivering fracture prevention services to rural US veterans through telemedicine: a process evaluation
- Creators
- Karla L Miller - Veterans Health AdministrationMelissa J Steffen - Iowa City VA Health Care SystemKimberly D McCoy - Iowa City VA Health Care SystemGrant Cannon - Veterans Health AdministrationAaron T Seaman - University of Iowa, General Internal MedicineZachary L Anderson - Veterans Health AdministrationShardool Patel - Veterans Health AdministrationJaniel Green - Veterans Health AdministrationShylo Wardyn - Veterans Health AdministrationSamantha L Solimeo - University of Iowa, General Internal Medicine
- Resource Type
- Journal article
- Publication Details
- Archives of osteoporosis, Vol.16(1), 27
- DOI
- 10.1007/s11657-021-00882-0
- PMID
- 33566174
- PMCID
- PMC7875846
- ISSN
- 1862-3522
- eISSN
- 1862-3514
- Language
- English
- Date published
- 12/01/2021
- Academic Unit
- Center for Social Science Innovation; General Internal Medicine; Community and Behavioral Health; Otolaryngology; Internal Medicine
- Record Identifier
- 9984359672802771
Metrics
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