Journal of Rehabilitation Research & Development (JRRD)

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Volume 53 Number 1, 2016
   Pages 147 — 156

Abstract — Implementation of telementoring for pain management in Veterans Health Administration: Spatial analysis

Evan P. Carey, MS;12* Joseph W. Frank, MD, MPH;1,3 Robert D. Kerns, PhD;4 P. Michael Ho, MD, PhD;1,5 Susan R. Kirsh, MD, MPH6

1Department of Veterans Affairs (VA) Eastern Colorado Health Care System, Denver, CO; 2Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO; 3Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO; 4VA Connecticut Healthcare System, West Haven, CT; and Yale School of Medicine, New Haven, CT; 5Department of Medicine, University of Colorado School of Medicine, Aurora, CO; 6Louis Stokes Cleveland VA Medical Center, Cleveland, OH; Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH; and Office of Specialty Care, Veterans Health Administration, Washington, DC

Abstract — In 2011, the Veterans Health Administration (VHA) implemented a pilot telementoring program across seven healthcare networks called the Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) for pain management. A VHA healthcare network is a group of hospitals and clinics administratively linked in a geographic area. We created a series of county-level maps in one network displaying (1) the location of Veterans with chronic pain, (2) VHA sites (i.e., coordinating center, other medical centers, outpatient clinics), (3) proportion of Veterans being seen in-person at pain specialty clinics, and (4) proportion of Veterans with access to a primary care provider participating in Pain SCAN-ECHO. We calculated the geodesic distance from Veterans' homes to nearest VHA pain specialty care clinics. We used logistic regression to determine the association between distance and Pain SCAN-ECHO primary care provider participation. Mapping showed counties closer to the Pain SCAN-ECHO coordinating center had a higher rate of Veterans whose providers participated in Pain SCAN-ECHO than those further away. Regression models within networks revealed wide heterogeneity in the reach of Pain SCAN-ECHO to Veterans with low spatial access to pain care. Using geographic information systems can reveal the spatial reach of technology-based healthcare programs and inform future expansion.

Key words:chronic pain, distance, ECHO, geographic information system, GIS, healthcare access, spatial, telemedicine, telementoring, Veteran, Veterans Health Administration.


View HTML ¦ View PDF ¦ Contents Vol. 53, No.1

This article and any supplementary material should be cited as follows:
Carey EP, Frank JW, Kerns RD, Ho PM, Kirsh SR. Implementation of telementoring for pain management in Veterans Health Administration: Spatial analysis. J Rehabil Res Dev. 2016;53(1):147–56.
http://dx.doi.org/10.1682/JRRD.2014.10.0247
ORCID: Evan P. Carey, MS: 0000-0001-7963-6818; Robert D. Kerns, PhD: 0000-0001-7609-2771
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