11/23/2015 1 A REVIEW: COMPREHENSIVE TBI EVALUATION 11/19/15 Adobe Connect Link: https://pittrstce.adobeconnect.com/vatbimeet / Conference Call-in Number is 866-236-9258 The telephones will be muted during the presentation and will open to the audience for discussion, questions, and answers during the last ½ hour. Please make sure you mute the microphones if you are listening from your computer. Type in comments or questions in the chat box any time during the session. Resource Materials and Handouts may be downloaded. 1 Clinical Champions Presenters • Joel Scholten, MD Physiatrist and TBI Specialist, Washington DC VAMC Special Projects, Physical Medicine and Rehabilitation, VA Central Office Physician Lead, CTBIE Teleconsultation Pilot e-mail: [email protected]• Nan Musson, M.A., CCC-SLP, BC-ANCDS Speech Language Pathologist, North Florida/South Georgia VHS Speech Pathology Discipline Lead Rehabilitation & Prosthetics Services, VA Central Office Project Lead, CTBIE Teleconsultation Pilot e-mail: [email protected]Overall objectives for the conference call: • Brief Background • Review Standardized CTBIE Utilizing Telehealth Technology • Business, Administrative, and Workload Capture • Building a Telehealth Team • Education/Training Available • Outcomes and Lessons Learned • The Future: Connected Care
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PowerPoint Presentation · -Neuro-psychiatrist Telepresenter: Any discipline TBI Speclialist and Telepresenter Responsibilities: Before the Teleconsultation During the Teleconsultation
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The IRCR Care Plan should be completed for EVERY individual who is being discharged from inpatient rehabilitation or receives outpatient rehabilitation services and meets the all of the following criteria:
• Diagnosed with TBI/Polytrauma;
• Referred to the TBI/Polytrauma team for assessment and treatment;
• Required and received interdisciplinary rehabilitation assessment including medical, case management PLUS at least one of the following; PT, OT, SLP, Psych, RT, KT, Voc, Blind Rehab;
• Determined to benefit from rehabilitation treatments for functional disabilities related to TBI/polytrauma;
• Rehabilitation treatments require intervention by interdisciplinary specialists including medical, case management PLUS at least one of the following: PT, OT, SLP, Psych, RT, KT, Voc, Blind Rehab.
Individualized Rehabilitation and Community
Reintegration (IRCR) Care Plan
Interdisciplinary Rehabilitation and Community Reintegration (IRCR) Care Plan
The following training modules were developed for the pilot:http://www.rstce.pitt.edu/VA_TBI/VATBI.html
(V05) (688) WASHINGTON VA MEDICAL CENTER 185 325 280 108 168 157
(V07) (508) ATLANTA VA MEDICAL CENTER 34 38 10 30 38 10
(V07) (521) BIRMINGHAM VA MEDICAL CENTER 7 9 7 9
(V08) (516) C.W. BILL YOUNG DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER 23 3 22 3
(V08) (673) JAMES A. HALEY VETERANS' HOSPITAL 17 21 14 16
(V10) (541) LOUIS STOKES CLEVELAND DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER 10 19 12 10 18 12
(V12) (578) EDWARD HINES JUNIOR HOSPITAL 5 7 5 7
(V16) (586) G.V. (SONNY) MONTGOMERY DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER 6 49 6 39
(V16) (598) JOHN L. MCCLELLAN MEMORIAL VETERANS' HOSPITAL 22 63 60 22 61 57
(V16) (623) JACK C. MONTGOMERY DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER 9 6 9 6
(V16) (629) NEW ORLEANS VA CLINIC 27 27
(V17) (549) DALLAS VA MEDICAL CENTER 80 126 105 71 104 81
(V17) (671) AUDIE L. MURPHY MEMORIAL VETERANS' HOSPITAL 3 8 3 8
(V18) (519) GEORGE H. O'BRIEN, JR., DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER 15 2 1 15 2 1
(V18) (678) TUCSON VA MEDICAL CENTER 22 20 7 20 18 7
(V20) (663) SEATTLE VA MEDICAL CENTER 8 22 18 8 22 18
(V21) (459) SPARK M. MATSUNAGA DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER 21 85 40 20 57 26
(V21) (612) MARTINEZ VA COMMUNITY LIVING CENTER 9 53 38 9 47 35
(V22) (600) LONG BEACH VA MEDICAL CENTER 3 3
(V22) (691) WEST LOS ANGELES VA MEDICAL CENTER 20 23 20 23
(V23) (636) OMAHA VA MEDICAL CENTER 11 21 4 11 21 4
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Pilot Project Outcomes Data
(Spread Sheet)
•Provider Location (Text)
•Provider Zip Code (5 digit number)
•TCT Location (Text)
•TCT Zip Code (5 digit number)
•Positive TBI Screen (MM/DD/YYYY)
•TBI Teleconsultation (MM/DD/YYYY)
•Did the TBI Specialist recommend a face-to-face visit to complete the exam (Yes/No)
•Referrals after the TBI evaluation:
•OT (Yes/No)
•PT (Yes/No)
•Speech Pathology (Yes/No)
•Neuropsychology (Yes/No)
•Interdisciplinary Care Plan initiated (Yes/No)
•Comment (open text)
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SLP = 54
PT = 86
Neuropsych = 48
Audiology = 44
Mental Health = 71
Optometry = 30
Referrals After Exam
OT SLP PT Neuropsych Audiology Mental Health Optometry
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Research
“Examining Telehealth Applications for Evaluation of
Mild Traumatic Brain Injury”
Bridget Smith, Principal Investigator
•Aim 1:
Characterize approaches to using telehealth to provide CTBIEs.
•Aim 2:
Examine the association between patient characteristics and use of telehealth to
perform the CTBIE and outcomes associated with telehealth.
•Aim 3:
Convene an expert panel and develop recommendations to facilitate the
implementation of telehealth strategies to provide comprehensive TBI evaluations.
•Aim 4:
Conduct a preliminary cost analysis.
Principal Findings:Responses indicated that there are far more advantages to utilizing CVT—including travel
convenience, cost-effectiveness, and patient satisfaction—than there are disadvantages.
The top challenges :
- challenges with scheduling (e.g.,
coordinating the schedules between
two different sites)
- setting up the clinic (e.g., space and
equipment requests)
- TBI Specialist learning to rely upon
the TCT to be their hands
Strategies utilized to improve the visit:
- establish good relationships and
communication with telehealth staff
and providers
- TBI specialists learning to establish
personal connection and rapport
with patients via telehealth
technology
- assuring resources are accessible
to the telepresenters/patients and
providers
VIRTUAL CAREThe possibilities are endless…..
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VIRTUAL CARE = “CONNECTED CARE”
Healthcare is moving to a virtual care delivery system.
•Movement of care goes beyond the hospital and clinics into the day-to-day lives of patients.
•The goal is to achieve “connected health,” which puts patients at the center of holistic care, beyond a symptom or disease focus.
•Creates and connects relationships between/among providers and between patients and their providers.
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Connected Care…
Home Telehealth (HT): Monitors patients and manages diseases through video into the home and use of mobile devices for acute and chronic management and health promotion/disease prevention.
Clinical Video Telehealth (CVT): Real-time videoconferencing between VA medical centers and CBOCs that replicates face-to-face consultations between patient and provider, or provider top provider. Uses include specialty consultations and delivery of mental health services.
Store and Forward Telehealth (SFT): Acquisition, storage, and forwarding of clinical images to experts for review.
Secure Messaging: Enables timely and secure text-based communication with patients via mobile phones.
Mobile Health: Smart phone applications for self-management of health conditions 24/7.
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Connected Care
My Healthe Vet
E-consult
Interfacility Consult
Concussion Coach
2) CVT to Clinic
Desktop and Education Cart
3) CVTHm (demo jabber
software/anywhere scheduler)
4) CVT Patient Tablets (issued via
DALC/ROES)
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TELEHEALTH NETWORK: PROVIDING CARE AND CONNECTING WITH SUBJECT MATTER EXPERTS
TBI Telehealth NetworkTeleconferencing with DoD, Families and Receiving Facilities
TBI Telehealth Pilot Sites
THE BIG PICTURE:
Networking, Follow-up, SME expertise and Mentoring
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TBI Telehealth Pilot Sites
THE BIG PICTURE: Follow-up Care
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Assistive Technology Labs:
7 Core Areas:
•Adaptive Computer Access
•Adaptive Driving
•Adaptive Sports
•Augmentative & Alternative Communication
•Electronic Aids to Daily Living
•Electronic Cognitive Devices
•Powered Mobility/Seating
Implementation of an Virtual Team:
Interfacility Consultation with CVT Teleconsultation Telina Caudill, Deborah Drewes, Tampa VAMC
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Transportable Exam Station (TES)
The “Suit Case”
• Located at many VISNs (approximately 198 nationally)
• A mobile tablet (6 hrs. battery life)
• CPRS access
• Peripherals (e.g., exam camera, pulse O2)
• Telehealth presenter or nurse may take into
the home or work setting
Group Education or Treatment
(multiple clinics at the same time)
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Home Telehealth Care Coordination for Chronic Conditions
mTBI Disease Management ProtocolScript developed for mTBI and the patient responds to the questions for a 28 day cycle.