Research Article

A Modeled Analysis of Telehealth Methods for Treating Pressure Ulcers after Spinal Cord Injury

Table 2

Characteristics of the usual care and telehealth care programs that were investigated.

Healthcare program
Usual care
(without telehealth)
option 1
option 2
option 3

Scenario  1: Preventive care
 Within SCI homecare catchment area
  MethodHome visit Telephone system video-conference unit connected with clinician
  Frequency of visits1 x/wk for 3 mo; 2 x/mo for 9 mo; patient visits SCI Center at 1 yearSubstitute 50% of usual care visits with telehealth
  Clinician time per visit120–360 min with travel time30 min
 Outside SCI homecare catchment area
  MethodTelephone contact with clinician and SCI Center visit; local outpatient facility visits as needed Same as within homecare catchmentTelephone system video-conference unit connected with patient, local facility, and SCI center
  Frequency of visitsSCI Center at 3 mo and 1 year; call at 6 moSame 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 visit30 min30 min45 min

Scenario  2: Existing pressure ulcer
 Within SCI homecare catchment area
  MethodHome visit: change dressing; take photo No telehealth options
  Frequency of visits1 x/wk, as needed
  Clinician time per visit240 minutes, includes digital photo
 Outside SCI homecare catchment area
  MethodContract with private nursing agencyaProvide digital camera to caregiver or nurse; photos sent to SCI center
  Frequency of visits1 x/wk until healed1 x/wk until healed
  Clinician time per visit30–60 min10 min to review photo; 30–45 min if videoconference with local facility is needed

Scenario  3: Postsurgical care
 Within SCI homecare catchment area
  Method Homecare visits Video-conference unit connected with clinician plus digital camera for patient or caregiverNo video-conference unit; digital camera to patient or caregiver only
  Frequency of visitsBy 1 mo, then 1-2 x/mo for 3 mos; additional SCI outpatient care as needed2 x/mo for 3 mos2 x/mo for 3 mos
  Clinician time per visit120–360 min30 min10 min
 Outside SCI homecare catchment area
  MethodPatient visits nearest VA facilityTelephone system video-conference unit connected with patient, local facility, and SCI centerSame as within homecare catchment area
  Frequency of visitsAt 1 mo; additional SCI outpatient care as needed (not an SCI Center)1-2 x/mo for 3 mos1-2 x/mo for 3 mos
  Clinician time per visit45–60 min30 min10 min

aAn alternative to hiring a contract nurse, not modeled here, would be to admit the patient to a skilled nursing facility.