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| Healthcare program |
| Usual care (without telehealth) | Telehealth option 1 | Telehealth option 2 | Telehealth option 3 |
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Scenario 1: Preventive care | | | | |
Within SCI homecare catchment area | | | | |
Method | Home visit | Telephone system video-conference unit connected with clinician | | |
Frequency of visits | 1 x/wk for 3 mo; 2 x/mo for 9 mo; patient visits SCI Center at 1 year | Substitute 50% of usual care visits with telehealth | | |
Clinician time per visit | 120–360 min with travel time | 30 min | | |
Outside SCI homecare catchment area | | | | |
Method | Telephone contact with clinician and SCI Center visit; local outpatient facility visits as needed | Same as within homecare catchment | Telephone system video-conference unit connected with patient, local facility, and SCI center | |
Frequency of visits | SCI Center at 3 mo and 1 year; call at 6 mo | Same as within homecare catchment, includes SCI Center visit at 1 year
| Same as within homecare catchment; plus patient visits local clinic, which teleconnects with SCI Center, at 1,3,6,9 mo | |
Clinician time per visit | 30 min | 30 min | 45 min | |
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Scenario 2: Existing pressure ulcer | | | | |
Within SCI homecare catchment area | | | | |
Method | Home visit: change dressing; take photo | No telehealth options | | |
Frequency of visits | 1 x/wk, as needed | | | |
Clinician time per visit | 240 minutes, includes digital photo | | | |
Outside SCI homecare catchment area | | | | |
Method | Contract with private nursing agencya | | | Provide digital camera to caregiver or nurse; photos sent to SCI center |
Frequency of visits | 1 x/wk until healed | | | 1 x/wk until healed |
Clinician time per visit | 30–60 min | | | 10 min to review photo; 30–45 min if videoconference with local facility is needed
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Scenario 3: Postsurgical care | | | | |
Within SCI homecare catchment area | | | | |
Method | Homecare visits | Video-conference unit connected with clinician plus digital camera for patient or caregiver | | No video-conference unit; digital camera to patient or caregiver only |
Frequency of visits | By 1 mo, then 1-2 x/mo for 3 mos; additional SCI outpatient care as needed | 2 x/mo for 3 mos | | 2 x/mo for 3 mos |
Clinician time per visit | 120–360 min | 30 min | | 10 min |
Outside SCI homecare catchment area | | | | |
Method | Patient visits nearest VA facility | Telephone system video-conference unit connected with patient, local facility, and SCI center | | Same as within homecare catchment area |
Frequency of visits | At 1 mo; additional SCI outpatient care as needed (not an SCI Center) | 1-2 x/mo for 3 mos | | 1-2 x/mo for 3 mos |
Clinician time per visit | 45–60 min | 30 min | | 10 min |
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