4028 — Refining the Implementation of a Hub-and-Spoke Model for the Delivery of Pain Management Care: A Qualitative Study

Lead/Presenter: Soumya Subramaniam,  VA Northeast Ohio Healthcare System
All Authors: Subramaniam S (VA Northeast Ohio Healthcare System, Cleveland), Chen J (Puget Sound VA Healthcare System, Seattle); Wilkerson T (VA Northeast Ohio Healthcare System, Cleveland); Stevenson L (VA Northeast Ohio Healthcare System, Cleveland); Kincaid C (Puget Sound VA Healthcare System, Seattle); Firestone C (VA Northeast Ohio Healthcare System, Cleveland); Ball S (VA Northeast Ohio Healthcare System, Cleveland)

Objectives:
The hub-and-spoke model leverages telehealth as a force multiplier for healthcare delivery. In a hub-and-spoke telehealth model, specialists located in larger healthcare facilities (e.g., academic medical centers) use video telehealth, telephone, and asynchronous telehealth (e.g., remote monitoring, secure messaging) to deliver services to patients participating from spoke clinics in their community or from home, thereby increasing access to specialty care. However, few studies address how to facilitate the adoption and implementation of this model. We examined spoke providers’ experiences with TelePain, a national hub-and-spoke model of interdisciplinary chronic pain care delivery using telehealth, with a focus on improving future implementation.

Methods:
Interviews were designed to explore VA providers’ experiences as spoke-site participants with TelePain. The implementation team obtained the names of providers at spoke sites, and all spoke-site providers were invited to participate in a one-time 20-45 minute interview. Individual interviews were conducted using an audio teleconferencing system and followed a semi-structured interview guide including extensive use of grounded probes. Interviews were audio recorded, transcribed and coded in a qualitative analysis software (Atlas.ti 8.0) using deductive (identified a priori and used to build the interview guide such as needs, roles of TelePain, veteran buy-in, referrals, and adoption) and inductive (emerging) codes.

Results:
Twenty-seven interviews were conducted from August 2020 to February of 2021. Our analysis identified the following themes stressed by the spoke sites: 1) spoke sites needed to envision how TelePain services would work at their site before deciding to adopt; 2) TelePain implementation needed to fit into local existing care processes; 3) hub sites needed to understand spoke sites’ context (e.g., via needs assessment) to tailor the services accordingly, and 4) hub and spoke sites needed to establish bidirectional communication.

Implications:
Our findings provide a practical guide to improve future rollout of hub-and-spoke telehealth models. Recommendations focus on the role of the hub site in promoting program adoption by 1) developing a clear and detailed marketing plan, and 2) considering how the program can be adapted to fit the local spoke site context. To improve implementation, hub and spoke sites must establish ongoing and consistent bidirectional communication; this is particularly critical in the everchanging post-peak pandemic healthcare system.

Impacts:
This presentation summarizes specific guidance for improving the implementation of hub-and-spoke telehealth models. We recommend that hub sites develop clear marketing plans and use bidirectional communication strategies to enhance adoption at the spoke sites.