Using the RE-AIM framework to assess national teledermatology expansion

Area of Science:

• Digital Health
• Telemedicine
• Dermatology

Background:

• Teledermatology use within the U.S. Department of Veterans Affairs (VA) has historically faced challenges with widespread adoption.
• A VA initiative since 2017 has aimed to improve dermatology access for rural Veterans through asynchronous teledermatology.
• This evaluation focuses on the second cohort (FY2020-2022) of this initiative, examining six VA facilities and 54 referral clinics.

Purpose of the Study:

• To assess the impact of a VA initiative aimed at enhancing teledermatology services for rural Veterans.
• To evaluate the reach, effectiveness, adoption, implementation, and maintenance of teledermatology programs.
• To understand the changes in teledermatology activity over three fiscal years of dedicated funding.

Main Methods:

• A mixed-methods approach was employed, utilizing facility online reports and VA administrative data.
• The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework guided the evaluation.
• Data from the funding period (FY2020-2022) were compared to a baseline year prior to the initiative's start.

Main Results:

• Teledermatology encounters increased by 100% and patient reach by 62% compared to the baseline.
• The proportion of dermatology encounters via teledermatology rose to 16% at funded facilities, exceeding the national average.
• Effectiveness showed improved dermatology program availability (83% vs. 71% of sites), and implementation was supported by continued funding for staff and equipment.

Conclusions:

• Targeted funding successfully expanded teledermatology reach, adoption, and implementation for rural Veterans, enhancing access to care.
• Program guidance, staffing, and training are crucial for maximizing the impact of teledermatology initiatives.
• Sustaining success requires ongoing efforts to foster communication between primary care and dermatology providers.