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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3081 — Improving Access to Liver Care among Urban Poor and Rural Veterans with Hepatitis C Associated Liver Disease: A Conceptual Framework

Rongey C (San Francisco VAMC), Connors E (San Francisco VAMC), Monto A (San Francisco VAMC), Asch S (West Los Angeles VAMC), Knight S (San Francisco VAMC)

To develop a conceptual framework with which to implement and evaluate liver telemedicine clinic based within an urban and rural community based outpatient clinic (CBOC).

We developed a conceptual framework which represents a hybrid of two established models: one that informs care in vulnerable populations and another that guides implementation research. Domains and processes were conceptualized using the Andersen Utilization Model and the PARiHS framework. The Andersen Model enriches a framework for understanding patient, provider, and contextual factors that influence utilization of health care services. The PARiHS model, used to guide implementation, was integrated with the Anderson model to provide a more comprehensive framework than either model alone. The Andersen Healthcare Utilization model provides the guide with which to collect healthcare system, geographic and individual as well as population based information to inform the Evidence and Context domains of the PARiHS model and, subsequently, our intervention.

Guided by the Andersen utilization model, we are conducting a pre-intervention assessment within each CBOC catchment area involving Veteran Health Administration (VHA) data analysis and patient surveys to determine Hepatitis C (HCV) disease burden and liver related healthcare utilization. In addition, we are conducting veteran focus groups exploring perceived barriers to and facilitators of telemedicine, perceptions of telemedicine care as well as reactions to the proposed model. Guided by the PARiHS framework, we are conducting provider and staff assessments exploring the PARiHS domains of evidence, facilitation and context. Supplementing the evidence domains, we are collecting data on timeliness of care and changes in liver related quality of care.

The proposed hybrid conceptual framework is directly guiding our telemedicine intervention and our subsequent assessment, which is ongoing. A liver telemedicine intervention’s likelihood of successfully improving health and utilization outcomes is correlated with VHA’s clinical and administrative perceived strength of evidence gathered and the context in which the evidence is reviewed.

A tested conceptual model can guide other VHA centers that are integrating research into clinical practice to improve access to specialty care among urban poor and rural veterans.

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