Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Laura Kuensting


Roberta Lavin


Amy Alter


Problem: Traumatic Brain Injuries (TBI) are known as the signature wound of veterans serving in Operation Enduring Freedom (OEF) and the Operation Iraqi Freedom (OIF). After the initial TBI diagnosis, outpatient TBI follow-up rates are reported to be approximately 9% less in the Veteran Healthcare Administration (VA) system when compared to the private sector. The purpose of this quality initiative was to decrease the rate of missed appointments among OEF/OIF veterans using a telehealth alternative.

Methods: The Plan-Do-Study-Act (PDSA) method was used to implement a consistent process for the telehealth visit option. A retrospective medical record review over the same 60-day period in 2017 and 2018 compared rates of in-person with telehealth visits.

Results: A total of 397 visits (N=397) in 2018 occurred. Most were in-person visits (n=382) with few telehealth visits (n=15); however, 73% of telehealth users had a history of missed appointments. The total rate of missed appointments declined from 30.5% in 2017 to 24.5% in 2018. The mean of 2017 missed appointments (M = 31.25, SD=1.08) was higher than the mean of 2018 missed appointments (M = 24.83, SD 4.26). The difference between the two means is statistically significant at the .05 level (t = 3.68, df=7, p = .014).

Implications for Practice: Physical travel to appointments impacted patients who had a history of difficulty accessing TBI care. The TBI outpatient population could attend an appointment using a telehealth alternative for clinic visits. The VA Connect Application provided a feasible alternative to a traditional in-person visit. Increasing access to TBI care may enhance recovery and quality of life for veterans.

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