Expanding Access to Comprehensive Geriatric Evaluation via Telehealth: Development of Hybrid-Virtual Home Visits

Background In response to the aging population, the Department of Veterans Affairs (VA) seeks to expand access to evidence-based practices which support community-dwelling older persons such as the Geriatric Resources for Assessment and Care of Elders (GRACE) program. GRACE is a multidisciplinary ca...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2024-02, Vol.39 (Suppl 1), p.36-43
Main Authors: Schubert, Cathy C., Penney, Lauren S., Schwartzkopf, Ashley L., Damush, Teresa M., Preddie, Alaina, Flemming, Soyna, Myers, Jennifer, Myers, Laura J., Perkins, Anthony J., Zhang, Ying, Bravata, Dawn M.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Data collection
Data transmission
Evaluation
Geriatrics
House Calls
Humans
Internal Medicine
Iterative methods
Medical instruments
Medicine
Medicine & Public Health
Older people
Patients
Problem solving
Program Development
Program Evaluation
Qualitative analysis
Quality control
Research and Reporting Methods
Telemedicine
Veterans
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Summary:Background In response to the aging population, the Department of Veterans Affairs (VA) seeks to expand access to evidence-based practices which support community-dwelling older persons such as the Geriatric Resources for Assessment and Care of Elders (GRACE) program. GRACE is a multidisciplinary care model which provides home-based geriatric evaluation and management for older Veterans residing within a 20-mile drive radius from the hospital. We sought to expand the geographic reach of VA-GRACE by developing a hybrid-virtual home visit (TeleGRACE). Objectives The objectives were to: (1) describe challenges encountered and solutions implemented during the iterative, pre-implementation program development process; and (2) illustrate potential successes of the program with two case examples. Design Quality improvement project with longitudinal qualitative data collection. Program Description The hybrid-virtual home visit involved a telehealth technician travelling to patients’ homes and connecting virtually to VA-GRACE team members who participated remotely. Approach & Participants We collected multiple data streams throughout program development: TeleGRACE staff periodic reflections, fieldnotes, and team meeting notes; and VA-GRACE team member interviews. Key Results The five program domains that required attention and problem-solving were: telehealth connectivity and equipment, virtual physical examination, protocols and procedures, staff training, and team integration. For each domain, we describe several challenges and solutions. An example from the virtual physical examination domain: several iterations were required to identify the combination of telehealth stethoscope with dedicated headphones that allowed remote nurse practitioners to hear heart and lung sounds. The two cases illustrate how this hybrid-virtual home visit model provided care for patients who would not otherwise have received timely healthcare services. Conclusions These results provide a blueprint to translate an in-person home-based geriatrics program into a hybrid-virtual model and support the feasibility of using hybrid-virtual home visits to expand access to comprehensive geriatric evaluation and ongoing care for high-risk, community-dwelling older persons who reside geographically distant from the primary VA facility. Graphical Abstract
ISSN:0884-8734
1525-1497
1525-1497
DOI:10.1007/s11606-023-08460-5