title: Evaluation and Treatment of Mild Traumatic Brain Injury Through the Implementation of Clinical Video Telehealth: Provider Perspectives From the Veterans Health Administration.
abstract: BACKGROUND
  Substantial numbers of U.S. military veterans who served in recent conflicts experience mild traumatic brain injury. Data suggest that as many as 25% of veterans do not have a comprehensive traumatic brain injury evaluation to determine a diagnosis and develop a plan to treat symptoms. Technologies like clinical video telehealth offer a potential means to overcome travel distance and other barriers that can impact veteran receipt of a comprehensive traumatic brain injury evaluation after a positive screening; however, little is known about implementing clinical video telehealth in this context.
  
  
  OBJECTIVE
  To examine the perspectives of Veterans Health Administration health care providers on implementing clinical video telehealth technology for the assessment and treatment of mild traumatic brain injury among veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn.
  
  
  METHODS
  Qualitative; semistructured interviews.
  
  
  METHODS
  Veterans Health Administration Polytrauma System of Care.
  
  
  METHODS
  Twenty-six providers who participated in a Veterans Health Administration Rehabilitation and Prosthetic Services Teleconsultation Pilot Project for administering comprehensive traumatic brain injury evaluations over clinical video telehealth.
  
  
  METHODS
  Semistructured interviews that used content-analytic techniques to assess provider experiences implementing clinical video telehealth for veterans with traumatic brain injury, including inhibiting factors and best practices to administer comprehensive traumatic brain injury evaluations.
  
  
  RESULTS
  The most commonly reported inhibiting factors to implementing clinical video telehealth for traumatic brain injury evaluation and treatment included scheduling, setting up the clinic, and conducting physical examinations over a virtual modality. To enhance clinical video telehealth implementation, participants described best practices including establishing solid communication and relationships with staff, building rapport with patients, and recognizing the unique needs of patients with traumatic brain injury.
  
  
  CONCLUSIONS
  Implementing clinical video telehealth programs involves coordinating multiple steps with providers at different sites, highlighting the need for effective communication. Provider-patient communication also emerged as vital to successful clinical video telehealth implementation. These findings suggest that providers would benefit from efforts to build communication competencies.
  
  
  METHODS
  Not applicable.
authors.affiliation: Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital, 5000 South 5(th) Ave (151H) Bldg 1 D304, Hines, IL 60141-5151(∗). Electronic address: rachael.n.martinez@va.gov.
authors.forename: Rachael N
authors.initials: RN
authors.lastname: Martinez
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA(†).
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Hogan
authors.affiliation: Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital, Hines, IL(‡).
authors.forename: Keshonna
authors.initials: K
authors.lastname: Lones
authors.affiliation: Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital, Hines, IL; and Center for Healthcare Studies, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL(§).
authors.forename: Salva
authors.initials: S
authors.lastname: Balbale
authors.affiliation: Physical Medicine and Rehabilitation, Rehabilitation and Prosthetics Service, VA Central Office, Washington, DC(¶).
authors.forename: Joel
authors.initials: J
authors.lastname: Scholten
authors.affiliation: Physical Medicine and Rehabilitation, Rehabilitation and Prosthetics Service, VA Central Office, Washington, DC(#).
authors.forename: Douglas
authors.initials: D
authors.lastname: Bidelspach
authors.affiliation: VHA Rehabilitation and Prosthetic Services, Gainesville VAMC, Gainesville, FL(∗∗).
authors.forename: Nan
authors.initials: N
authors.lastname: Musson
authors.affiliation: Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital, Hines, IL; and Feinberg School of Medicine, Northwestern University, Chicago, IL(††).
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Smith
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000368:Aged; D001291:Attitude of Health Personnel; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D017216:Telemedicine; D014728:Veterans; D049269:Videoconferencing