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2019 HSR&D/QUERI National Conference Abstract

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1136 — Innovation to Sustainment: Computer-Based Mapping for VA Home-Based Primary Care Programs

Lead/Presenter: Jacqueline Fickel,  COIN - Los Angeles
All Authors: Fickel JJ (Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles), Ong MK (Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles), Lind JD (Center of Innovation on Disability and Rehabilitation Research, Tampa) Bradley SE (Center of Innovation on Disability and Rehabilitation Research, Tampa) Cowper-Ripley D (Center of Innovation on Disability and Rehabilitation Research, Gainesville; VA Office of Rural Health, Geospatial Outcomes) Bergman AA (Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles) Katzburg JR (Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles) Leatherman R (Charles George VAMC, Asheville) Fleming M (Office of Reporting, Analytics, Performance, Improvement, and Deployment) Halladay C (Center for Innovation in Long-Term Services and Supports for Vulnerable Veterans, Providence) Tubbesing SA (Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles)

Objectives:
Home-Based Primary Care (HBPC) provides services for Veterans with complex, chronic conditions. Geographic Information System (GIS) mapping can improve efficiency of access to care. However, HBPC teams generally have little experience with GIS mapping. We describe the progression from pilot testing this field-based GIS mapping innovation in HBPC, through implementing and evaluating the spread across the national VA HBPC practice community, and establishing sustainment in regular program operations.

Methods:
A multi-disciplinary coordination team provided support and implementation facilitation for HBPC partner sites to learn and use GIS mapping via a secure, user-friendly internet portal. Mixed-method, site-level evaluation used quantitative utilization and survey data, plus qualitative data from semi-structured interviews, to assess extent of adoption, satisfaction, facilitators and barriers, and to explore impacts. Formative evaluation feedback from partner site experiences was used to refine implementation tools and processes, resulting in a toolkit that includes training, technical, and other implementation support materials. Ongoing collaboration with VA stakeholders has focused on development of GIS mapping resources to support enterprise-wide spread and sustainment of training, technical support, a steering committee, and the HBPC-GIS user community.

Results:
Implementation has spread from a single site (2012) to 30 diverse HBPC sites (2018). The most common map uses include assigning patients to providers, optimizing territories, managing patients with high clinical risk, increasing travel efficiency for care teams, identifying areas for program expansion, and emergency preparedness. The most common barriers to GIS use are staff turnover and competing demands. In response to feedback, training materials were revised and made more easily accessible. In-depth evaluation for one site, who used GIS maps to optimize patient reassignments while reducing staff in an expanded clinical service area, found that nurse practitioners involved in the reassignments saw 33.3% more patients (60.0, Q1FY2016, to 90.3, Q1FY2017) and traveled 30.4% fewer miles per patient (128.9, Q1FY2016, to 89.7, Q1FY2017) after GIS-supported reorganization.

Implications:
With this method of tailored implementation support, a wide range of HBPC programs can learn and use on-line GIS mapping tools, given adequate staff skills, training, and time.

Impacts:
GIS use can improve access by increasing efficiency and enrollment capacity for patient-centered, home-based primary care.