title: Targeting Access to Kidney Care Via Telehealth: The VA Experience.
abstract: The Veterans Affairs (VA) is the largest integrated health care system in the United States and is responsible for the care of a population with a disproportionately high rate of CKD. As such, ensuring access to kidney health services is a VA imperative. One facet of the VA's strategy to reduce CKD is to leverage the use of teletechnology to expand the VA's outreach to Veterans with kidney disease. A wide array of teletechnology services have been deployed to both pull in Veterans and push out kidney health services to Veterans in their preferred health care venue. Teletechnology, thus, expands Veteran choice, facilitates their access to care, and furthers the goal of delivering patient-centered kidney specialty care. The VA has demonstrated the feasibility of virtual delivery of kidney specialty care services and education via synchronous and asynchronous approaches. The challenges ahead include determining the relative health care value of kidney telehealth services, identifying Veterans most likely to benefit from specific technologies and optimizing the adoption of effective kidney telehealth services by both providers and patients alike to ensure optimal and timely kidney health care delivery.
authors.affiliation: Department of Medicine, Section of Nephrology, VA Connecticut Healthcare System, West Haven, CT; Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT; Department of Medicine, Section of Nephrology, Salem VA Medical Center, Salem, VA; Department of Medicine, Section of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA; Department of Medicine, Section of Nephrology, VA Puget Sound Healthcare System, Seattle, WA; Division of Nephrology, University of Washington School of Medicine, Seattle, WA; Department of Medicine, Section of Nephrology, VA White River Junction VAMC, White River Junction, VT; Department of Medicine, Section of Nephrology, Dartmouth School of Medicine, Hanover, NH; Department of Medicine, Section of Nephrology, VA Northport Healthcare Systems, Northport, NY; and Department of Medicine, Section of Nephrology, State University of New York at Stony Brook School of Medicine, Stony Brook, NY. Electronic address: susan.crowley@va.gov.
authors.forename: Susan T
authors.initials: ST
authors.lastname: Crowley
authors.affiliation: Department of Medicine, Section of Nephrology, VA Connecticut Healthcare System, West Haven, CT; Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT; Department of Medicine, Section of Nephrology, Salem VA Medical Center, Salem, VA; Department of Medicine, Section of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA; Department of Medicine, Section of Nephrology, VA Puget Sound Healthcare System, Seattle, WA; Division of Nephrology, University of Washington School of Medicine, Seattle, WA; Department of Medicine, Section of Nephrology, VA White River Junction VAMC, White River Junction, VT; Department of Medicine, Section of Nephrology, Dartmouth School of Medicine, Hanover, NH; Department of Medicine, Section of Nephrology, VA Northport Healthcare Systems, Northport, NY; and Department of Medicine, Section of Nephrology, State University of New York at Stony Brook School of Medicine, Stony Brook, NY.
authors.forename: Justin
authors.initials: J
authors.lastname: Belcher
authors.affiliation: Department of Medicine, Section of Nephrology, VA Connecticut Healthcare System, West Haven, CT; Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT; Department of Medicine, Section of Nephrology, Salem VA Medical Center, Salem, VA; Department of Medicine, Section of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA; Department of Medicine, Section of Nephrology, VA Puget Sound Healthcare System, Seattle, WA; Division of Nephrology, University of Washington School of Medicine, Seattle, WA; Department of Medicine, Section of Nephrology, VA White River Junction VAMC, White River Junction, VT; Department of Medicine, Section of Nephrology, Dartmouth School of Medicine, Hanover, NH; Department of Medicine, Section of Nephrology, VA Northport Healthcare Systems, Northport, NY; and Department of Medicine, Section of Nephrology, State University of New York at Stony Brook School of Medicine, Stony Brook, NY.
authors.forename: Devasmita
authors.initials: D
authors.lastname: Choudhury
authors.affiliation: Department of Medicine, Section of Nephrology, VA Connecticut Healthcare System, West Haven, CT; Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT; Department of Medicine, Section of Nephrology, Salem VA Medical Center, Salem, VA; Department of Medicine, Section of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA; Department of Medicine, Section of Nephrology, VA Puget Sound Healthcare System, Seattle, WA; Division of Nephrology, University of Washington School of Medicine, Seattle, WA; Department of Medicine, Section of Nephrology, VA White River Junction VAMC, White River Junction, VT; Department of Medicine, Section of Nephrology, Dartmouth School of Medicine, Hanover, NH; Department of Medicine, Section of Nephrology, VA Northport Healthcare Systems, Northport, NY; and Department of Medicine, Section of Nephrology, State University of New York at Stony Brook School of Medicine, Stony Brook, NY.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Griffin
authors.affiliation: Department of Medicine, Section of Nephrology, VA Connecticut Healthcare System, West Haven, CT; Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT; Department of Medicine, Section of Nephrology, Salem VA Medical Center, Salem, VA; Department of Medicine, Section of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA; Department of Medicine, Section of Nephrology, VA Puget Sound Healthcare System, Seattle, WA; Division of Nephrology, University of Washington School of Medicine, Seattle, WA; Department of Medicine, Section of Nephrology, VA White River Junction VAMC, White River Junction, VT; Department of Medicine, Section of Nephrology, Dartmouth School of Medicine, Hanover, NH; Department of Medicine, Section of Nephrology, VA Northport Healthcare Systems, Northport, NY; and Department of Medicine, Section of Nephrology, State University of New York at Stony Brook School of Medicine, Stony Brook, NY.
authors.forename: Raymond
authors.initials: R
authors.lastname: Pichler
authors.affiliation: Department of Medicine, Section of Nephrology, VA Connecticut Healthcare System, West Haven, CT; Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT; Department of Medicine, Section of Nephrology, Salem VA Medical Center, Salem, VA; Department of Medicine, Section of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA; Department of Medicine, Section of Nephrology, VA Puget Sound Healthcare System, Seattle, WA; Division of Nephrology, University of Washington School of Medicine, Seattle, WA; Department of Medicine, Section of Nephrology, VA White River Junction VAMC, White River Junction, VT; Department of Medicine, Section of Nephrology, Dartmouth School of Medicine, Hanover, NH; Department of Medicine, Section of Nephrology, VA Northport Healthcare Systems, Northport, NY; and Department of Medicine, Section of Nephrology, State University of New York at Stony Brook School of Medicine, Stony Brook, NY.
authors.forename: Brooks
authors.initials: B
authors.lastname: Robey
authors.affiliation: Department of Medicine, Section of Nephrology, VA Connecticut Healthcare System, West Haven, CT; Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT; Department of Medicine, Section of Nephrology, Salem VA Medical Center, Salem, VA; Department of Medicine, Section of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA; Department of Medicine, Section of Nephrology, VA Puget Sound Healthcare System, Seattle, WA; Division of Nephrology, University of Washington School of Medicine, Seattle, WA; Department of Medicine, Section of Nephrology, VA White River Junction VAMC, White River Junction, VT; Department of Medicine, Section of Nephrology, Dartmouth School of Medicine, Hanover, NH; Department of Medicine, Section of Nephrology, VA Northport Healthcare Systems, Northport, NY; and Department of Medicine, Section of Nephrology, State University of New York at Stony Brook School of Medicine, Stony Brook, NY.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Rohatgi
authors.affiliation: Department of Medicine, Section of Nephrology, VA Connecticut Healthcare System, West Haven, CT; Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT; Department of Medicine, Section of Nephrology, Salem VA Medical Center, Salem, VA; Department of Medicine, Section of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA; Department of Medicine, Section of Nephrology, VA Puget Sound Healthcare System, Seattle, WA; Division of Nephrology, University of Washington School of Medicine, Seattle, WA; Department of Medicine, Section of Nephrology, VA White River Junction VAMC, White River Junction, VT; Department of Medicine, Section of Nephrology, Dartmouth School of Medicine, Hanover, NH; Department of Medicine, Section of Nephrology, VA Northport Healthcare Systems, Northport, NY; and Department of Medicine, Section of Nephrology, State University of New York at Stony Brook School of Medicine, Stony Brook, NY.
authors.forename: Bessie
authors.initials: B
authors.lastname: Mielcarek
mesh_terms: D019033:Delivery of Health Care, Integrated; D006297:Health Services Accessibility; D006801:Humans; D009398:Nephrology; D010353:Patient Education as Topic; D018802:Patient-Centered Care; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D017216:Telemedicine; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: Access to health care; Health services; Kidney disease; Patient education as topic; Telemedicine