Sustainment of the TeleSleep program for rural veterans

Jeffrey K Belkora; Linda Ortiz DeBoque; Robert L Folmer; Annette M Totten; Katherine Williams; Mary A Whooley; Eilis Boudreau; Charles W Atwood; Michelle Zeidler; Talayeh Rezayat; Priyanka Chilakamarri; Kathleen F Sarmiento

doi:10.3389/frhs.2023.1214071

Sustainment of the TeleSleep program for rural veterans

Front Health Serv. 2023 Nov 10:3:1214071. doi: 10.3389/frhs.2023.1214071. eCollection 2023.

Authors

Jeffrey K Belkora^{1

2}, Linda Ortiz DeBoque³, Robert L Folmer^{3

4}, Annette M Totten⁵, Katherine Williams^{6

7}, Mary A Whooley^{6

7}, Eilis Boudreau^{5

8}, Charles W Atwood^{9

10}, Michelle Zeidler^{11

12}, Talayeh Rezayat^{1

13}, Priyanka Chilakamarri^{1

14}, Kathleen F Sarmiento^{1

7}

Affiliations

¹ San Francisco VA Health Care System, San Francisco, CA, United States.
² Institute for Health Policy Studies and Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.
³ VA Portland Health Care System, Portland, OR, United States.
⁴ Department of Otolaryngology, Oregon Health & Science University, Portland, OR, United States.
⁵ Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States.
⁶ Measurement Science Quality Enhancement Research Initiative, San Francisco VA Health Care System, San Francisco, CA, United States.
⁷ Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.
⁸ Department of Neurology, Oregon Health & Science University, Portland, OR, United States.
⁹ Pulmonary Section and Sleep Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States.
¹⁰ Division of Pulmonary, Allergy, Critical Care Medicine, UPMC and University of Pittsburgh, Pittsburgh, PA, United States.
¹¹ Pulmonary, Critical Care, and Sleep Medicine, VA Greater Los Angeles Health Care System, Los Angeles, CA, United States.
¹² Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
¹³ Department of Medicine, University of Nevada, Reno, NV, United States.
¹⁴ Department of Neurology, University of California, San Francisco, San Francisco, CA, United States.

Abstract

Background: In fiscal year 2021, the Veterans Health Administration (VHA) provided care for sleep disorders to 599,966 Veterans, including 189,932 rural Veterans. To further improve rural access, the VA Office of Rural Health developed the TeleSleep Enterprise-Wide Initiative (EWI). TeleSleep's telemedicine strategies include tests for sleep apnea at the Veteran's home rather than in a sleep lab; Clinical Video Telehealth applications; and other forms of virtual care. In 2017 and 2020, VHA provided 3-year start-up funding to launch new TeleSleep programs at rural-serving VA medical facilities.

Methods: In early 2022, we surveyed leaders of 24 sites that received TeleSleep funding to identify successes, failures, facilitators, and barriers relevant to sustaining TeleSleep implementations upon expiration of startup funding. We tabulated frequencies on the multiple choice questions in the survey, and, using the survey's critical incident framework, summarized the responses to open-ended questions. TeleSleep program leaders discussed the responses and synthesized recommendations for improvement.

Results: 18 sites reported sustainment, while six were "on track." Sustainment involved medical centers or regional entities incorporating TeleSleep into their budgets. Facilitators included: demonstrating value; aligning with local priorities; and collaborating with spoke sites serving rural Veterans. Barriers included: misalignment with local priorities; and hiring delays. COVID was a facilitator, as it stimulated adoption of telehealth practices; and also a barrier, as it consumed attention and resources. Recommendations included: longer startup funding; dedicated funding for human resources to accelerate hiring; funders communicating with local facility leaders regarding how TeleSleep aligns with organizational priorities; hiring into job classifications aligned with market pay; and obtaining, from finance departments, projections and outcomes for the return on investment in TeleSleep.

Keywords: implementation science; maintenance; sleep medicine; sustainment; telemedicine.

Grants and funding

This work was supported by the VA Office of Rural Health TeleSleep Enterprise-Wide Initiative.