Outpatient telecardiology perceptions among rural, suburban, and urban veterans utilizing in-person cardiology versus telecardiology services: A mixed methods analysis.

PURPOSE: To better understand opportunities and barriers to implementation and adoption, this mixed-methods study qualitatively examined attitudes toward telecardiology services among veterans who use in-person (IP) outpatient cardiology service versus those using telecardiology (TC) outpatient services. METHODS: Free-text responses were collected from N = 179 veterans enrolled in Veteran Health Administration (VHA) IP or TC services in 3 rural-serving, outpatient telehealth clinics and 1 large, metropolitan outpatient center. Mixed-method analyses of responses included thematic analysis, followed by comparison of code categories and themes between IP and TC groups. FINDINGS: Fifteen thematic coding categories were identified, which comprised 4 valence categories (favorable or unfavorable attitudes toward TC and IP), as well as themes pertaining to obstacles and opportunities for TC implementation. Overall, veterans enrolled in TC held more favorable attitudes toward TC than those enrolled in IP. Veteran responses included structural concerns (eg, time demands, access, and travel), as well as humanistic qualities (rapport, competence, and face-to-face contact). Differences were observed between the responses of veterans who reported dwelling in urban, suburban, and rural communities, with rural-identifying veterans generally holding more favorable attitudes toward TC than suburban-identifying veterans. CONCLUSIONS: TC users had overwhelmingly positive perceptions of TC. Conversely, unfavorable attitudes from IP patients toward TC did not appear to be borne out in the responses of TC users. On the contrary, TC users' responses may indicate opportunities for allaying the concerns of TC-naïve veterans. This suggests promise for developing tailored education to dispel barriers for TC service implementation.

A nurse practitioner-led effort to reduce 30-day heart failure readmissions.

BACKGROUND: Heart failure (HF) affects over 6.5 million Americans and is the leading reason for hospital admissions in patients over the age of 65. Readmission rates within 30 days are 21.4% nationally, and 12% of those are likely preventable. Veterans are especially vulnerable to developing cardiac diseases requiring hospitalization and subsequent readmission. LOCAL PROBLEM: The Southern Arizona Veterans Administration Health Care System has over 5,600 patients diagnosed with HF and a 30-day readmission rate of 21.65%. The aim of this quality improvement project was to reduce 30-day all-cause readmissions by 1% over 8 weeks. METHODS: To reduce HF readmissions, the plan-do-study-act rapid-cycle method of quality improvement was used. INTERVENTIONS: A dedicated multidisciplinary HF clinic was formed with a cardiology nurse practitioner, clinical pharmacists, and a dietician. A veteran-centered shared decision-making tool for setting self-care goals was implemented. RESULTS: The readmission rate of patients seen in the multidisciplinary clinic (n = 33) was reduced by 0.2%. The percentage of veterans seen within 14 days increased from 30% to 54.5%. The average number of days between discharge and cardiology follow-up improved from 45 to 19 days. Veterans were able to set at least one self-care goal 87% of the time. Patient satisfaction with the multidisciplinary clinic was high at 93%. CONCLUSIONS: Implementing a dedicated, multidisciplinary HF clinic reduced readmissions, improved timeliness of visits, and was well received. Use of a veteran-centered patient engagement tool resulted in more veterans setting self-care goals.