title: Mixed-methods evaluation of a telehealth collaborative care program for persons with HIV infection in a rural setting.
abstract: BACKGROUND
  Delivery of comprehensive care for persons with human immunodeficiency virus (HIV) infection in rural and low prevalence settings presents many challenges. We developed and evaluated a telehealth collaborative care (TCC) program for persons with HIV in a rural area.
  
  
  OBJECTIVE
  To determine the feasibility of TCC, and identify factors influencing implementation in rural settings.
  
  
  METHODS
  Mixed methods evaluation of a quality improvement program with pre-measures and post-measures.
  
  
  METHODS
  Veterans with HIV infection in Iowa and Illinois.
  
  
  METHODS
  TCC integrated HIV specialty care delivered by clinical video telehealth, with primary care delivered by generalist providers, in seven Community Based Outpatient Clinics (CBOCs) serving rural areas. Principles guiding TCC design were: 1) clear delineation of specialty and primary care clinic roles in co-managed care; 2) creation of processes to improve care coordination between specialty and primary care teams; and 3) use of a patient registry for population management across sites.
  
  
  METHODS
  Veterans Affairs (VA) healthcare system performance measures for care for HIV infection and common comorbidities, patient travel time to obtain care, and patient satisfaction. Qualitative evaluation involved semi-structured telephone interviews with patients.
  
  
  RESULTS
  Thirty of 32 eligible patients chose TCC over traveling to the HIV clinic for all care. Among 24 patients in TCC during the June 2011-May 2012 evaluation period, median age was 54 (range, 40-79), most (96 %) were men, and median CD4 count was 707 cells/cm(3) (range, 233-1307). VA performance measures were met for > 90 % of TCC patients. Median yearly travel time decreased from 320 min per patient prior to TCC to 170 min during TCC (p < 0.001). Interview themes included: 1) overcoming privacy concerns during care in local primary care clinics; 2) tradeoffs between access, continuity, and care coordination; and 3) the role of specialist involvement in collaborative care.
  
  
  CONCLUSIONS
  Telehealth Collaborative Care is a feasible approach to providing accessible and comprehensive care for persons with HIV in rural settings.
authors.affiliation: VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region, Iowa City VAMC, Iowa City, IA, USA. michael.ohl@va.gov
authors.forename: Michael
authors.initials: M
authors.lastname: Ohl
authors.forename: Dena
authors.initials: D
authors.lastname: Dillon
authors.forename: Jane
authors.initials: J
authors.lastname: Moeckli
authors.forename: Sarah
authors.initials: S
authors.lastname: Ono
authors.forename: Nancee
authors.initials: N
authors.lastname: Waterbury
authors.forename: Jo
authors.initials: J
authors.lastname: Sissel
authors.forename: Jun
authors.initials: J
authors.lastname: Yin
authors.forename: Brian
authors.initials: B
authors.lastname: Neil
authors.forename: Bonnie
authors.initials: B
authors.lastname: Wakefield
authors.forename: Peter
authors.initials: P
authors.lastname: Kaboli
mesh_terms: D000328:Adult; D000368:Aged; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005069:Evaluation Studies as Topic; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006297:Health Services Accessibility / Q000458:organization & administration; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007087:Illinois; D007484:Iowa; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration*; D017216:Telemedicine / Q000458:organization & administration*