Open AccessFactors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study
Author(s) -
Naim Naim,
Sydney DeStefano,
Alison Banger,
Regina Rutledge,
Melissa Romaire
Publication year - 2021
Publication title -
jmir formative research
Language(s) - English
Resource type - Journals
ISSN - 2561-326X
DOI - 10.2196/24118
Subject(s) - telehealth , reimbursement , workforce , medicaid , workflow , nursing , business , specialty , qualitative research , telemedicine , medicine , family medicine , health care , computer science , political science , social science , database , sociology , law
Background Telehealth has potential to help individuals in rural areas overcome geographical barriers and to improve access to care. The factors that influence the implementation and use of telehealth in critical access hospitals are in need of exploration. Objective The aim of this study is to understand the factors that influenced telehealth uptake and use in a set of frontier critical access hospitals in the United States. Methods This work was conducted as part of a larger evaluation of a Centers for Medicare & Medicaid Services–funded demonstration program to expand cost-based reimbursement for services for Medicare beneficiaries for frontier critical access hospitals. Our sample was 8 critical access hospitals in Montana, Nevada, and North Dakota that implemented the telehealth aspect of that demonstration. We reviewed applications and progress reports for the demonstration program and conducted in-person site visits. We used a semistructured discussion guide to facilitate conversations with clinical, administrative, and information technology staff. Using NVivo software (QSR International), we coded the notes from the interviews and then analyzed the themes. Results Several factors influenced the implementation and use of telehealth in critical access hospitals, including making changes to workflow and infrastructure as well as practitioner acceptance and availability. Participants also cited technical assistance and support for implementation as supportive factors. Conclusions Frontier critical access hospitals may adopt telehealth to overcome challenges such as distance from specialty practitioners and workforce challenges. Telehealth can be used for provider-to-patient and provider-to-provider interactions to improve access to care, remove barriers, and improve quality. However, the ability of telehealth to improve outcomes is limited by factors such as workflow and infrastructure changes, practitioner acceptance and availability, and financing.