Graduation Date

Summer 8-17-2018

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research, Administration, and Policy

First Advisor

Fernando A. Wilson


Telehealth technologies are becoming more pervasive throughout the healthcare system as a way to provide services to patients that would otherwise have difficulty with access. Currently, little is known about the current state of telehealth use within clinics and hospital in the US. Most studies evaluating telehealth programs are feasibility or small patient outcome studies from one location. Utilizing a hybrid framework combining the levels of complex socio-technical systems with the theory of ready, willing and able. The theory of ready, willing, and able is founded on the basis that these three preconditions need to be met for a change in behavior to occur, such as adoption of telehealth technologies.

Study 1 utilizes multiple national healthcare data sets to analyze the higher levels of organizational factors that are associated with US hospitals who are ready and willing to implement telehealth technologies but lack the ability. Providing insight to the factors that can facilitate the ability to adopt such innovations. Study 2 is a mixed methods study that evaluates clinic data from the state of Nebraska. The quantitative survey data was used to develop interview questions and determine the sample population. The qualitative interviews yielded several themes on barriers to implementing and sustaining telehealth services in Nebraska. These include lack of providers to network with and technology malfunction issues. Many clinics want to increase their telehealth programs but are lacking the ability to do so. Study 3 is a combination of two meta-analyses that evaluate the effect of telehealth programs on the QOL for cancer patients in treatment and cancer survivors who are no longer in active treatment. The effect of the telehealth interventions on survivors QOL is significantly increased compared to survivors in usual care.

More needs to be done to standardize telehealth evaluation and connection processes. Positive patient outcomes and clinical benefits can strengthen the legitimacy of telehealth technologies as part of normal healthcare practice. Yet without accurate data, the benefits cannot be fully assessed. Innovation is outpacing policy and procedures, this needs to be amended to fully maximize the benefits of telehealth technologies in the healthcare system.