Browsing by Subject "Veterans Affairs"

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    Building Cohesion in Distributed Telemedicine Teams Findings from the Department of Veterans Affairs National Telestroke Program
    (2020-07-16) Patel, Himalaya; Damush, Teresa M.; Miech, Edward J.; Rattray, Nicholas A.; Martin, Holly A.; Savoy, April; Plue, Laurie; Anderson, Jane; Martini, Sharyl; Graham, Glenn D,; Williams, Linda S.; Richard L. Roudebush VA Medical Center
    Background: As telemedicine adoption increases, so does the importance of building cohesion among physicians in telemedicine teams. For example, in acute telestroke services, stroke specialists provide rapid virtual stroke assessment and treatment to patients at hospitals without stroke specialty care. In the National Telestroke Program (NTSP) of the U.S. Department of Veterans Affairs, a virtual (distributed) hub of stroke specialists throughout the country provides 24/7 consultations nationwide. We examined how these specialists adapted to distributed teamwork, and we identied cohesion-related factors inprogram development and support. Methods: We conducted a case study of the stroke specialists employed by the NTSP. Semi-structured, condential interviews with stroke specialists in the virtual hub were recorded and transcribed. We explored the extent to which these specialists had developed a sense of shared identity and teamcohesion, and we identied factors in this development. Using a qualitative approach with constant comparison methods, two researchers coded each interview transcript independently using a shared codebook. We used matrix displays to identify themes, with special attention to team cohesion, communication, trust, and satisfaction. Results: Of 13 specialists with at least 8 months of NTSP practice, 12 completed interviews; 7 had previously practiced in telestroke programs in other healthcare systems. Interviewees reported high levels of trust and team cohesion, sometimes even more with their virtual colleagues than with local colleagues. Factors facilitating perceived team cohesion included a weekly case conference call, a sense of transparency in discussing challenges, engagement in NTSP development tasks, and support from the NTSP leadership. Although lack of in-person contact was associated with lower cohesion, annual in-person NTSP meetings helped mitigate this issue. Despite technical challenges in establishing a new telehealth system within existing national infrastructure, providers reported high levels of satisfaction with the NTSP.Conclusion: A virtual telestroke hub can provide a sense of team cohesion among stroke specialists at a level comparable with a standard co-located practice. Engaging in transparent discussion of challenging cases, reviewing new clinical evidence, and contributing to program improvements may promotecohesion in distributed telemedicine teams
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    Defining adenoma detection rate benchmarks in average-risk male veterans
    (Elsevier, 2018) El-Halabi, Mustapha M.; Rex, Douglas K.; Saito, Akira; Eckert, George J.; Kahi, Charles J.; Medicine, School of Medicine
    Background and Aims Veterans have higher prevalence of colorectal neoplasia than non-veterans; however, it is not known whether specific Veterans Affairs (VA) adenoma detection rate (ADR) benchmarks are required. We compared ADRs of a group of endoscopists for colonoscopies performed at a VA to their ADRs at a non-VA academic medical center. Methods This was a retrospective review of screening colonoscopies performed by endoscopists who practice at the Indianapolis VA and Indiana University (IU). Patients were average-risk males aged 50 years or older. ADR, proximal adenoma detection rate, advanced adenoma detection rate, and adenomas per colonoscopy were compared between IU and the VA groups. Results Six endoscopists performed screening colonoscopies at both locations during the study period (470 at IU vs 608 at the VA). The overall ADR was not significantly different between IU and the VA (58% vs 61%; p =0.21). Advanced neoplasia detection rate (13% vs 17%; p=0.46), proximal adenoma detection rate (46% vs 47%; p=0.31), and adenoma per colonoscopy (1.59 vs 1.84; p=0.24) were not significantly different. There were no significant differences in cecal intubation rate (100% vs 99%; p=0.13) or withdrawal time (10.9 vs 11.1 min; p=0.28). In regression analysis, there was significant correlation between the attending-specific ADRs at IU and the VA (p=0.041, r-square=0.69). Conclusions In this study of average-risk males undergoing screening colonoscopies by the same group of endoscopists, the ADRs of VA and non-VA colonoscopies were not significantly different. This suggests that a VA-specific ADR target is not required for endoscopists with high ADR.