Administrator and provider perceptions of the factors relating to programme effectiveness in implementing telemedicine to provide end-of-life care

Two large hospice organizations in Kansas and Michigan began a telehospice project with the goal of improving care at the end of life using telemedici ne. Hospice nurses provided services using video directly to the homes of h ospice patients. The telemedicine equipment operated over ordinary telephon e lines. Nursing services included symptom assessment and psychospiritual e valuations. Patients lived in both urban and rural settings. Studies were d esigned to evaluate utilization-patterns, access to care, patient/carer acc eptance, medical outcomes and Cost. During the first year of the project, t elehospice care was initiated at five rural sites (two in Michigan and thre e in Kansas) and three urban sites (two in Michigan and one in Kansas). The re was greater telehospice activity in Michigan than in Kansas, with 118 an d 44 patients served, respectively. The urban site in Kansas withdrew from the study after participating for only nine months. In an effort to underst and the difference in utilization patterns and reasons for withdrawing from the project, in-depth interviews of key study participants, including hosp ice administrators, nurses and research personnel, were conducted. Human fa ctors appear to be important in the adoption of novel telemedicine applicat ions.