Use of a Standardized Telehealth Visit Tool to Improve Care Outcomes of Veterans in Home-based Primary Care

Abstract

In the United States, approximately two million homebound, older adults have chronic health conditions and disabilities. Providing primary care to this high-risk population is challenging and requires evidence-based strategies to address higher treatment noncompliance, lower medication adherence, decreased continuum of care, higher risk for hospitalizations, and disproportionately high healthcare costs. This project implemented evidence-based practice (EBP) of a standardized telehealth visit tool to increase access to primary care for homebound veterans. Anticipated outcomes included an increase in telehealth visits, holistic documentation, and a decrease in emergency room (ER) visits post-implementation. A synthesis of literature highlighted best practices during telehealth visits to include utilization of a standardized tool. A telehealth visit tool was developed to guide visits conducted by nurse case managers and other providers in a home-based primary care (HBPC). During a three-month period, telehealth visits were offered to all veterans enrolled in the HBPC program located in the Northeast region in the United States. Data including demographics, number of telehealth visits, tool usage, and number of ER visits and hospitalizations with diagnosis were analyzed pre- and postimplementation. Telehealth visits improved access to care for homebound veterans with a 373.3% increase in the total number. The standardized tool assisted nurse case managers and providers to maximize the benefits of and promote continuity of primary care using telehealth. Hospitalizations and ER visits did not decrease, perhaps due to the short implementation period, an increase in COVID-19 cases, and the high-risk population’s multiple comorbidities.