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)	Telehealth; option 1	Telehealth; option 2	Telehealth; option 3
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
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 agency^a			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
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

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