1135 — Telehealth for Surgical Follow-Up of Veterans: Examining Indications, Outcomes, and Patient Preferences

Kummerow Broman KL, VA Tennessee Valley Healthcare System; Vella MA, VA Tennessee Valley Healthcare System; Tarpley JL, VA Tennessee Valley Healthcare System; Dittus RS, VA Tennessee Valley Healthcare System; Roumie CL, VA Tennessee Valley Healthcare System;

Objectives:
Veterans Health Administration (VHA) has invested in telehealth to improve access to care, but there has been little evaluation of this process in surgical care. Our aims were to determine the predictors of postoperative care that is amenable to telehealth, measure quality of telehealth visits, and evaluate Veterans' visit preferences.

Methods:
We retrospectively reviewed the postoperative clinic visits for Veterans who underwent a general surgical operation at VA Tennessee Valley Healthcare System between July 2012 and July 2013 using CPRS to identify telehealth amenable care (TAC). TAC was defined as: postoperative care accomplished in a single visit, without an invasive procedure or focal concern, and no new complication diagnosed or managed. In a convenience sample of 23 Veterans, we then prospectively measured telehealth visit quality and preferences by providing all three of the following visit types over a two day period around Veterans' scheduled post-operative visits: telephone, in-person, and mock video visits. Visit quality was measured by percent concordance of visit findings in four domains: general recovery, follow-up needs, wound needs, and complications. Finally, we examined the association of Veteran visit preference with travel distance.

Results:
We reviewed 251 patients, 94% male, mean age 60 years (±12.0), with a mean of 1.5 post-operative visits (±0.98). Forty-six percent (115/251) met criteria for TAC. On multivariable analysis, age, comorbidities, and elective versus emergent operation did not predict TAC. Postoperative length of stay < 4 days predicted TAC (OR 5.53, 95% CI 1.82-16.74), as did low complexity abdominal operations (laparoscopic appendectomy/cholecystectomy, umbilical/inguinal hernia repair) (4.61, 1.67-12.68). In the prospective study, percent concordance between the 3 visit types was 100% for general recovery and follow-up needs, and 96% for wound needs and complications. Over two-thirds of Veterans preferred a telehealth visit (30% video, 39% phone). Veterans who preferred telehealth visits travelled further for care (mean 162 vs. 75 miles, p = 0.03).

Implications:
Nearly half of postoperative visits are potentially amenable to telehealth care. Telehealth visits revealed similar clinical findings as clinic visits and were preferred by Veterans.

Impacts:
Increased telehealth utilization for postoperative Veterans holds promise to alleviate wait times, decrease costs, and increase access to patient-centered care.