Application of Telehealth to Overcome Geographic Disparities in Liver Transplantation within the Veterans Health Administration

Many centers within the Veterans Health Administration have limited access to hepatology and transplant specialists. Liver transplantation is centralized and performed at six approved VA transplant centers (VATC). Geographic disparities are associated with lower access to transplantation, decreased placement onto the national waitlist and poorer survival in Veterans residing over a hundred miles from a VATC. The aim of this study was to evaluate if telehealth (TH) can reduce the timeframe of performing liver transplant evaluations compared to usual care (UC) in Veterans referred for liver transplantation across vast geographic distances. A retrospective, descriptive, comparative analysis of electronic medical records of approximately 200 Veterans was conducted to evaluate for differences in time from referral to a listing decision using TH versus UC visits in Veterans referred for liver transplant consideration to a VATC from 10/01/2011- 9/30/2016. A total sample size (n=140) included 102 subjects in the TH group and 38 subjects in the UC group. The mean time from referral to initial evaluation in the TH group was 22 days (SD=7.0) and 23.4 days (SD=15.3) in the UC group. Mean time from referral to listing decision was 108 days (SD=55.8) in the TH group and 90 days (SD=94.6) in the UC group. The independent samples t-test revealed no significant differences in the mean times were detected at these specific time intervals conducted by TH or UC visits. Preliminary findings suggest that conducting transplant evaluations by TH were no different than UC. Telehealth has the potential to improve access to specialized transplant services, reduce travel burden for Veterans and increase the successful navigation across the complex transplant process in a timely manner, regardless of the site of care.