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Elnitsky C, Latlief G, Gavin-Dreschnack D, Harris M, Campbell R. Lessons learned in pilot testing specialty consultations to benefit individuals with lower limb loss. Int J Telerehabil 2012; 4:3-10. [PMID: 25945199 PMCID: PMC4296827 DOI: 10.5195/ijt.2012.6097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Telerehabilitation technologies enable the delivery of rehabilitation services from providers to people with disabilities as well as specialty care consultations. This article discusses the barriers experienced when planning and pilot testing a telerehabilitation multi-site specialty consultation for specialists in their medical centers, and the lessons learned. The barriers included integration and participation, coordination across organizational units, and privacy and information security. Lessons learned included the need for collaboration across multiple departments, telerehabilitation equipment back-ups, and anonymous and private communication protocols. Despite delays resulting from coordination at multiple levels of a national organization, we developed a program plan and successfully implemented a pilot test of the southeast region program. Specialty consultation using telerehabilitation delivery methods requires identifying provider preferences for technological features. Lessons learned could inform development of outpatient telerehabilitation for patients with amputations and studies of patients and providers involved in telerehabilitation.
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Affiliation(s)
- Christine Elnitsky
- Health Services Research and Development & Rehabilitation Research and Development Center of Excellence in Maximizing Rehabilitation Outcomes, James A. Haley Veterans' Hospital, Tampa, Florida ; Uniformed Services University of the Health Sciences, Graduate Program in Nursing, Bethesda, Maryland ; Veterans Integrated Service Network 8, Patient Safety Center of Inquiry, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Gail Latlief
- Health Services Research and Development & Rehabilitation Research and Development Center of Excellence in Maximizing Rehabilitation Outcomes, James A. Haley Veterans' Hospital, Tampa, Florida ; Regional Amputation Center, James A. Haley Veterans' Hospital, Tampa, Florida ; University of South Florida, College of Medicine, Tampa, Florida
| | - Deborah Gavin-Dreschnack
- Health Services Research and Development & Rehabilitation Research and Development Center of Excellence in Maximizing Rehabilitation Outcomes, James A. Haley Veterans' Hospital, Tampa, Florida ; Veterans Integrated Service Network 8, Patient Safety Center of Inquiry, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Melanie Harris
- Regional Amputation Center, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Robert Campbell
- Health Services Research and Development & Rehabilitation Research and Development Center of Excellence in Maximizing Rehabilitation Outcomes, James A. Haley Veterans' Hospital, Tampa, Florida ; Veterans Integrated Service Network 8, Patient Safety Center of Inquiry, James A. Haley Veterans' Hospital, Tampa, Florida
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Chumbler NR, Quigley P, Sanford J, Griffiths P, Rose D, Morey M, Ely EW, Hoenig H. Implementing telerehabilitation research for stroke rehabilitation with community dwelling veterans: lessons learned. Int J Telerehabil 2010; 2:15-22. [PMID: 25945169 PMCID: PMC4296788 DOI: 10.5195/ijt.2010.6047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Telerehabilitation (TR) is the use of telehealth technologies to provide distant support, rehabilitation services, and information exchange between people with disabilities and their clinical providers. This article discusses the barriers experienced when implementing a TR multi-site randomized controlled trial for stroke patients in their homes, and the lessons learned. The barriers are divided into two sections: those specific to TR and those pertinent to the conduct of tele-research. The TR specific barriers included the rapidly changing telecommunications and health care environment and inconsistent equipment functionality. The barriers applicable to tele-research included the need to meet regulations in diverse departments and rapidly changing research regulations. Lessons learned included the need for: telehealth equipment options to allow for functionality within a diverse telecommunications infrastructure; rigorous pilot testing of all equipment in authentic situations; and on-call and on-site biomedical engineering and/or IT staff.
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Affiliation(s)
- Neale R Chumbler
- VA HSR&D Center of Excellence on Implementing Evidence Based Practice (CIEBP), Richard L. Roudebush VAMC, Indianapolis, IN ; Department of Sociology, Indiana University School of Liberal Arts, Indiana University Purdue University Indianapolis, Indianapolis, IN ; VA HSR&D Stroke Quality Enhancement Research Initiative (QUERI) Program, Richard L. Roudebush VAMC, Indianapolis, IN ; Regenstrief Institute, Indianapolis, IN
| | | | - Jon Sanford
- Atlanta VA Rehab R&D Center, Atlanta VAMC, Atlanta GA
| | - Patricia Griffiths
- Atlanta VA Rehab R&D Center, Atlanta VAMC, Atlanta GA ; Emory University School of Medicine, Div. of Geriatrics and Gerontology, Atlanta, GA
| | - Dorian Rose
- University of Florida, College of Public Health and Health Professions, Gainesville, FL
| | - Miriam Morey
- Department of Medicine, Duke University Medical Center, Durham, NC ; Geriatric Research Education and Clinical Center, Durham VAMC, Durham, NC
| | - E Wesley Ely
- Vanderbilt University Medical Center, Nashville, TN ; Tennessee Valley Healthcare System, VA Geriatric Research Education and Clinical Center, Nashville, TN
| | - Helen Hoenig
- Physical Medicine & Rehabilitation Service, Durham VAMC, Durham, NC ; Department of Medicine, Duke University Medical Center, Durham, NC
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Brown M, Shaw N. Evaluation Practices of a Major Canadian Telehealth Provider: Lessons and Future Directions for the Field. Telemed J E Health 2008; 14:769-74. [DOI: 10.1089/tmj.2007.0126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Snowdon C, Elbourne DR, Garcia J, Campbell MK, Entwistle VA, Francis D, Grant AM, Knight RC, McDonald AM, Roberts I. Financial considerations in the conduct of multi-centre randomised controlled trials: evidence from a qualitative study. Trials 2006; 7:34. [PMID: 17184521 PMCID: PMC1781076 DOI: 10.1186/1745-6215-7-34] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 12/21/2006] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Securing and managing finances for multicentre randomised controlled trials is a highly complex activity which is rarely considered in the research literature. This paper describes the process of financial negotiation and the impact of financial considerations in four UK multicentre trials. These trials had met, or were on schedule to meet, recruitment targets agreed with their public-sector funders. The trials were considered within a larger study examining factors which might be associated with trial recruitment (STEPS). METHODS In-depth semi-structured telephone interviews were conducted in 2003-04 with 45 individuals with various responsibilities to one of the four trials. Interviewees were recruited through purposive and then snowball sampling. Interview transcripts were analysed with the assistance of the qualitative package Atlas-ti. RESULTS The data suggest that the UK system of dividing funds into research, treatment and NHS support costs brought the trial teams into complicated negotiations with multiple funders. The divisions were somewhat malleable and the funding system was used differently in each trial. The fact that all funders had the potential to influence and shape the trials considered here was an important issue as the perspectives of applicants and funders could diverge. The extent and range of industry involvement in non-industry-led trials was striking. Three broad periods of financial work (foundation, maintenance, and resourcing completion) were identified. From development to completion of a trial, the trialists had to be resourceful and flexible, adapting to changing internal and external circumstances. In each period, trialists and collaborators could face changing costs and challenges. Each trial extended the recruitment period; three required funding extensions from MRC or HTA. CONCLUSION This study highlights complex financial aspects of planning and conducting trials, especially where multiple funders are involved. Recognition of the importance of financial stability and of the need for appropriate training in this area should be paralleled by further similar research with a broader range of trials, aimed at understanding and facilitating the conduct of clinical research.
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Affiliation(s)
- Claire Snowdon
- Medical Statistics Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- Centre for Family Research, Free School Lane, Cambridge, CB2 3 RF, UK
| | - Diana R Elbourne
- Medical Statistics Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Jo Garcia
- Medical Statistics Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Marion K Campbell
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK
| | - Vikki A Entwistle
- Social Dimensions of Health Institute, Universities of Dundee and St Andrews, Airlie Place, Dundee DD1 4HJ, UK
| | - David Francis
- Centre for Research and Innovation Management, Brighton, UK
| | - Adrian M Grant
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK
| | - Rosemary C Knight
- Medical Statistics Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Alison M McDonald
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK
| | - Ian Roberts
- Nutrition and Public Health Interventions Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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May C. A rational model for assessing and evaluating complex interventions in health care. BMC Health Serv Res 2006; 6:86. [PMID: 16827928 PMCID: PMC1534030 DOI: 10.1186/1472-6963-6-86] [Citation(s) in RCA: 250] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2006] [Accepted: 07/07/2006] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Understanding how new clinical techniques, technologies and other complex interventions become normalized in practice is important to researchers, clinicians, health service managers and policy-makers. This paper presents a model of the normalization of complex interventions. METHODS Between 1995 and 2005 multiple qualitative studies were undertaken. These examined: professional-patient relationships; changing patterns of care; the development, evaluation and implementation of telemedicine and related informatics systems; and the production and utilization of evidence for practice. Data from these studies were subjected to (i) formative re-analysis, leading to sets of analytic propositions; and to (ii) a summative analysis that aimed to build a robust conceptual model of the normalization of complex interventions in health care. RESULTS A normalization process model that enables analysis of the conditions necessary to support the introduction of complex interventions is presented. The model is defined by four constructs: interactional workability; relational integration; skill set workability and contextual integration. This model can be used to understand the normalization potential of new techniques and technologies in healthcare settings CONCLUSION The normalization process model has face validity in (i) assessing the potential for complex interventions to become routinely embedded in everyday clinical work, and (ii) evaluating the factors that promote or inhibit their success and failure in practice.
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Affiliation(s)
- Carl May
- Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA, UK.
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