Developing a Home Telehealth Program to Manage Pressure Ulcers in SCI/D

The Veteran's Health Administration (VHA) is a national leader in using distance technology to monitor patients' self-care via an in-home messaging device with disease management protocols (DMPs). No such DMPs exist for the community dwelling spinal cord injury/disorders (SCI/D) population. Our objective is to develop the tools necessary for implementing a new home telehealth program to manage community-dwelling veterans with SCI/D at high risk of developing pressure ulcers (PrUs).

Background: VHA is a national leader in using distance technology to monitor patients' self-care via an in-home messaging device with disease management protocols (DMPs). No such DMPs exist for the community dwelling spinal cord injury/disorders (SCI/D) population. Our objective is to develop the tools necessary for implementing a new home telehealth program to manage community-dwelling veterans with SCI/D at high risk of developing pressure ulcers (PrUs). Objectives: The goal of the study was to complete activities necessary in preparation for implementing a Home Telehealth program to manage veterans with SCI/D at risk of developing PrUs. Specifically this Rapid Response Project (RRP) included: 1) Convening an expert panel to validate Pressure Ulcer (PrU) PrU DMP items; 2) Developing a standardized protocol that specified how the nurse Care Coordinator who would manage patients who develop open skin wounds across the Hub and Spoke system of care; 3) Assessing individual telehealth DMP items by calling a sample of patients on a daily or weekly basis for up to 2 months to determine their validity and 4) Developing an instrument to assess staff satisfaction with this method of patient management. Methods: A convenience sample of veterans about to be discharged home from the Cleveland SCI/D inpatient unit were asked to participate in the study. This included patients living close to the Hub and those referred from spoke sites. Subjects were randomly assigned to receive either daily calls (5 days/week) for 40 total calls, or weekly calls (8 total calls) over the course of the 8 week/2month study intervention period. Status: The project team is conducting ongoing analysis of the data to develop publications.

Patients randomized to this group receive daily phone calls to remind them what they should do to prevent ulcers

Patients randomized to this group receive weekly phone calls to remind them what they should do to prevent ulcers.

Patients randomized to this group receive daily phone calls to remind them what they should do to prevent ulcers.

Patients randomized to this group receive weekly phone calls to remind them what they should do to prevent ulcers.

Measured the number of days with triggers that occurred on the Baseline day, during the 8-week intervention, and on the End of Study day.

Inclusion Criteria: - Veterans admitted to Cleveland VA SCI/D unit or treated in the outpatient clinic Exclusion Criteria: No phone Cognitive impairment Hearing impairment

Woo C, Guihan M, Frick C, Gill CM, Ho CH. What's happening now! Telehealth management of spinal cord injury/disorders. J Spinal Cord Med. 2011;34(3):322-31. doi: 10.1179/2045772311Y.0000000003. Erratum In: J Spinal Cord Med. 2011 Jul;34(4):437.