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Implementing Teledermatology for Rural Veterans: An Evaluation Using the RE-AIM Framework.

Sara B Peracca¹, George L Jackson^2,3, Rebecca P Lamkin⁴

¹Dermatology Service, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.

Telemedicine Journal and E-Health : the Official Journal of the American Telemedicine Association

|April 29, 2020

Summary

This study evaluated a teledermatology program for rural veterans in the U.S. Department of Veterans Affairs (VA), finding successful implementation and sustainability with key facilitators like leadership support.

Keywords:

dermatology e-health policy teledermatology telehealth

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Area of Science:

Health Services Research
Digital Health
Telemedicine

Background:

Systematic evaluations of large-scale teledermatology implementation are scarce.
The U.S. Department of Veterans Affairs (VA) expanded asynchronous consultative teledermatology for rural veterans.

Purpose of the Study:

To conduct a longitudinal evaluation of the VA teledermatology initiative.
To assess the reach, effectiveness, adoption, implementation, and maintenance of the program.

Main Methods:

Utilized the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.
Analyzed quantitative VA administrative data and conducted an online survey of participating facilities.
Compared the first two years of the program with the pre-funding year.

Main Results:

Sixteen hub facilities increased reach, serving more remote patients and increasing encounters.
Teledermatology became a larger part of dermatology activity; adoption progressed with identified facilitators and barriers.
Program Sustainability Index scores indicated strong executive support but highlighted concerns regarding staffing and long-term funding.

Conclusions:

Enabling hubs to tailor solutions enhanced reach and effectiveness.
Organizational leadership and stakeholder communication were crucial facilitators.
The VA teledermatology program demonstrated high implementation and sustainability, with identified areas for improvement.