2017 HSC Section 2 - Practice Management

Reprinted by permission of Head Neck. 2016; 38(6):925-929.

ORIGINAL ARTICLE

Consultation via telemedicine and access to operative care for patients with head and neck cancer in a Veterans Health Administration population

Daniel M. Beswick, MD, 1,2 Anita Vashi, MD, MPH, 3 Yohan Song, MD, 1,2 Rosemary Pham, MS, 2 F. Chris Holsinger, MD, 2 James D. Rayl, CNP, 4 Beth Walker, MSPT, 5 John Chardos, MD, 6 Annie Yuan, NP, 1 Ella Benadam–Lenrow, RN, 1 Dolores Davis, RN, FNP, MSN, 7 C. Kwang Sung, MD, MS, 1,2 Vasu Divi, MD, 1,2 Davud B. Sirjani, MD 1,2 * 1 Department of Otolaryngology – Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California, 2 Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, 3 Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Palo Alto, California, 4 Department of Otolaryngology – Head and Neck Surgery, New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico, 5 Ambulatory Care Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California, 6 Department of Medicine, Stanford University School of Medicine, Stanford, California, 7 Department of Surgery, Central California Veterans Affairs Health Care System, Fresno, California.

Accepted 4 December 2015 Published online 21 February 2016 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/hed.24386

ABSTRACT: Background. The purpose of this study was to evaluate a telemedicine model that utilizes an audiovisual teleconference as a preoper- ative visit. Methods. Veterans Health Administration (VHA) patients with head and neck cancer at 2 remote locations were provided access to the Palo Alto Veterans Affairs (PAVA) Health Care System otolaryngology department via the telemedicine protocol: tissue diagnosis and imaging at the patient site; data review at PAVA; and a preoperative teleconference connecting the patient to PAVA. Operative care occurred at PAVA. Follow-up care was provided remotely via teleconference. Results. Fifteen patients were evaluated. Eleven underwent surgery, 4 with high-grade neoplasms (carcinoma). Average time from referral to INTRODUCTION Head and neck cancer is a complex disease that is optimally treated with a multidisciplinary care team and a well- developed infrastructure. For patients who reside at a signifi- cant distance from a center with these capacities, determin- ing a treatment plan and providing subsequent intervention can be associated with significant delays as well as travel- related costs and inconveniences. Even without such geo- graphic hurdles, the average delay from referral to definitive treatment for cancers of the upper aerodigestive tract has been estimated at 14 to 21 weeks in the United States and Canada. 1 The Veterans Health Administration (VHA) is the largest healthcare system in the United States, providing compre-

operation was 28 days (range, 17–36 days) and 72 (range, 31–108 days), respectively, for high-grade and low-grade groups. The average patient was spared 28 hours traveling time and $900/patient was saved on travel-related costs. Conclusion. A telemedicine model enables timely access to surgical care and permits considerable savings among select VHA patients with head and neck cancer. V C 2016 Wiley Periodicals, Inc. Head Neck 38: 925–929, 2016 KEY WORDS: telemedicine, telehealth, head and neck, cancer, access, Veterans Health Administration, Veterans Affairs hensive healthcare to almost 9 million veterans annually. 2 The VHA system is not immune to treatment delays, a problem that has not only been highlighted recently in the press 3,4 but also spurred governmental action. 5 Traditionally, VHA patients who live in remote areas and present with new diagnoses of head and neck cancer are transported to tertiary care VHA hospitals for evalua- tion and workup, or their care is fee-based to a local, non-Veterans Affairs tertiary care hospital. Transporting patients to tertiary care VHA hospitals can be associated with travel-related delays because patients with head and neck cancer often require multiple visits before beginning treatment to evaluate the tumor and determine a care plan. The use of non-VHA hospitals can permit rapid access to non-VA health systems, 6 but can be associated with significant costs for the VHA healthcare system. Telemedicine has been proposed as a mechanism to facil- itate treatment of head and neck cancer. 7 To date, telemedi- cine has been used to remotely present patients with head and neck cancer at multidisciplinary tumor boards 8–11 and provide guidance via secure text messaging as patients undergo treatment. 12,13 To our knowledge, no prior studies have evaluated the role of telemedicine in remote presurgi- cal evaluation, workup, and counseling for patients with

* Corresponding author: D. Sirjani, Department of Otolaryngology – Head and Neck Surgery, 801 Welch Road, Stanford, CA 94305. E-mail: dsirjani@ohns. stanford.edu This work was presented as a poster at the Triological Society’s Combined Otolaryngology Spring Meeting in Boston, Massachusetts, April 23, 2015. This work represents the views of the authors and not the Veterans Health Administration.

HEAD & NECK—DOI 10.1002/HED JUNE 2016

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