A Descriptive Analysis of a Rural Telehospital Medicine Program in the Veterans Health Administration: A Multi-Facility, Mixed-Methods Evaluation.

PURPOSE: The Veterans Health Administration (VHA) reports provider shortages in up to 86% of their hospitals, with rural VHA Medical Centers (VAMCs) disproportionately affected. To address this, the VHA's Office of Rural Health launched the Telehospital Medicine Program to provide hospitalist coverage in understaffed facilities. This evaluation describes adoption and expansion of this program across six rural VHA hospitals. METHODS: Using a mixed-methods approach guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework, we evaluated implementation across six VHA facilities. Reach was assessed by measuring the number of inpatient bed days of care at rural facilities served by the Telehospital Medicine Program. Costs were evaluated through a budget impact analysis, while adoption, implementation, and maintenance were examined using facility-, provider-, and individual-level metrics, and staff and Veteran interviews and surveys. FINDINGS: On average, the Telehospital Medicine Program covered an average of 87 beds per day, with a range of 50-395 beds per day across the six facilities analyzed. Estimated savings for the facilities served range from $72K to $1.05M per year, equivalent to a reduction on average of ∼1.5 full-time equivalents of on-site providers, with the largest hospitals perceiving the largest savings. Additionally, no increases in length of stay, hospital readmissions, or mortality rates were observed following implementation. Factors influencing adoption include "hesitancy among newer nurses," "training components for residents and advanced practice providers," and "technology logistics." Staff found the program easy to integrate and effective in filling care gaps. Maintenance remained robust 6 months after implementation. CONCLUSIONS: The VHA's rural Telehospital Medicine Program demonstrated scalability, adaptability, and sustainability across a variety of practice settings-highlighting the program's ability to meet varying staffing needs across rural VHA facilities.