title: Evaluation of a national telemedicine initiative in the Veterans Health Administration: Factors associated with successful implementation.
abstract: Background The Consolidated Framework for Implementation Research was used to evaluate implementation facilitators and barriers of Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) within the Veterans Health Administration. SCAN-ECHO is a video teleconferencing-based programme where specialist teams train and mentor remotely-located primary care providers in providing routine speciality care for common chronic illnesses. The goal of SCAN-ECHO was to improve access to speciality care for Veterans. The aim of this study was to provide guidance and support for the implementation and spread of SCAN-ECHO. Methods Semi-structured telephone interviews with 55 key informants (primary care providers, specialists and support staff) were conducted post-implementation with nine sites and analysed using Consolidated Framework for Implementation Research constructs. Data were analysed to distinguish sites based on level of implementation measured by the numbers of SCAN-ECHO sessions. Surveys with all SCAN-ECHO sites further explored implementation information. Results Analysis of the interviews revealed three of 14 Consolidated Framework for Implementation Research constructs that distinguished between low and high implementation sites: design quality and packaging; compatibility; and reflecting and evaluating. The survey data generally supported these findings, while also revealing a fourth distinguishing construct - leadership engagement. All sites expressed positive attitudes toward SCAN-ECHO, despite struggling with the complexity of programme implementation. Conclusions Recommendations based on the findings include: (a) expend more effort in developing and distributing educational materials; (b) restructure the delivery process to improve programme compatibility;
authors.affiliation: 1 Louis Stokes Cleveland VA Medical Center, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Stevenson
authors.affiliation: 1 Louis Stokes Cleveland VA Medical Center, USA.
authors.forename: Sherry
authors.initials: S
authors.lastname: Ball
authors.affiliation: 2 Eastern Colorado Health Care System, USA.
authors.forename: Leah M
authors.initials: LM
authors.lastname: Haverhals
authors.affiliation: 1 Louis Stokes Cleveland VA Medical Center, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Aron
authors.affiliation: 3 VA Ann Arbor Health Care System, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Lowery
mesh_terms: D005260:Female; D006284:Health Plan Implementation / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D018802:Patient-Centered Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration; D014728:Veterans; D058014:Veterans Health / Q000706:statistics & numerical data*
keywords: Implementation research; chronic illness; healthcare education; healthcare training; speciality care; telehealth; telemedicine