Efficacy and sustainability of a telerehabilitation program

Sustainability and appropriateness of care are important components for healthcare systems as they begin integrating telemedicine/telehealth as an integral part of their healthcare delivery. Part of sustainability is incorporating a variety of approaches and technology, utilizing lower-cost options when appropriate. INTEGRIS is formalizing criteria to incorporate a mixture of technological approaches based on the first three years of direct clinical intervention and educational experience. Technology options, clinical outcomes, patient´s perception of quality of life, and reimbursement are components that must be considered. Technology considerations include the healthcare application, bandwidth requirements, and technology needs, focusing on type of technology rather than specific brands or companies. Patient acceptance/fear of different technologies and other intangible factors must be incorporated into the equation. Telecommunications utilized range from a secure internal wide area network (WAN) with dedicated broad bandwidth systems using H320 and H323 to connecting into a public telecommunications backbone to analog options. Telemedicine/ Telehealth equipment is located in a variety of sites including hospitals, public schools, rural health clinics, physician offices and patient homes. A variety of peripherals are utilized to enhance service delivery based on disease or healthcare needs. This paper provides an overview of telerehabilitation and how it is used for patient intervention. It addresses the different telehealth applications, what has shown to be most successful, which promote sustainability of the program, what problems have been encountered, and how those problems have been addressed. Information includes data from outcome studies and patient satisfaction. Technology options that are cost effective today will be discussed. Finally, the authors will conjecture what is on the horizon for tomorrow. The purpose of this paper is to discuss the potential of TeleRehab™ for meeting unmet needs, for providing improved quality of service, and for continuing rehabilitation beyond the shortened length of stay into home and community-based settings. Program feasibility, development, implementation and sustainability are addressed.