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2019 HSR&D/QUERI National Conference Abstract

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2005 — Bringing Veteran Care Closer to Home: Priorities, Partnerships, and Engaged Research and Evaluation of Virtual Patient-Facing Technologies

Lead/Presenter: George Sayre,  COIN- Seattle/Denver
All Authors: Sayre GG (Puget Sound HSR&D; Seattle/Denver COIN; Department of Health Services, University of Washington) Zulman DM (Center for Innovation to Implementation, VA Palo Alto) Heyworth L (Office of Connected Care/Telehealth; Univ of California, San Diego) Carey EP (Saint Louis University Department of Health Data Science Center for Health Outcomes Research (SLUCOR) Young JP (Puget Sound HSR&D; Seattle/Denver COIN) Fortney JC (University of Washington Department of Psychiatry; Puget Sound HSR&D; Seattle/Denver COIN) Kuhn E (Center for Mobile Apps Research Resources and Services, VA National Center for PTSD) Hogan T (eHealth Partnered Evaluation Initiative, Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center)

Objectives:
While the VA continues its efforts to improve Veteran access to community care through the Mission Act, only 1 percent of Veterans who live more than 40 miles from a VA facility who were eligible for Choice opted for community care. Improving access to VA care for these Veterans who prefer VA care or face clinical, social, and geographic barriers to in-person care makes expansions in telehealth capabilities for patient-facing technology increasingly critical for the VA, especially as Vietnam-era Veterans age and younger Veterans who are more tech-savvy opt for telehealth first. This forum will bring together program leadership from the Offices of Connected Care (Leonie Heyworth), Veteran Access to Care (Susan Kirsh), and Geriatrics (Tom Edes), and Rural Health (Kelly Lora Lewis) with Veterans, SRD investigators who are actively studying or interested in studying patient-facing technology. The objectives will be to: 1) discuss current program initiatives to virtually expand the scope and range of VA services provided to Veterans living in both rural and urban areas and ongoing HSRD, QUERI, and operations-funded projects related to those initiatives, 2) share information about relevant data sources and analytic resources, 3) identify the priorities and questions to guide future VA research efforts involving effective patient-facing technology, 4) generate a research agenda that supports transformation of healthcare services into the home, considering specifically the most effective patient-facing technology or combination of technologies for each unique Veteran, and 5) understand the clinical and economic impact of leveraging patient-facing technologies to expand care into the home. Participants and attendees will work collaboratively to identify and clarify future virtual care research and evaluation priorities and questions and to draft specific, actionable research goals/aims. Special focus will be paid to generating partnership opportunities, engagement strategies, inclusion of Veterans, methods, and dissemination strategies associated with each research priority/goal. Participants will also troubleshoot challenges and limitations common to virtual care research and evaluation.

Methods:
1. Introductions (45 minutes): Introductory remarks from operational partners Dr. Leonie Heyworth (VA Video Connect expansion into the home USH initiative), Dr. Tom Edes (HBPC, Intermediate Care Technicians/MISSION Act), Dr. Susan Kirsh (Underserved facilities, access standards and improving capacity) and Dr Kelly Lora Lewis (Rural Access Needs). Program leadership will present: 1) current program initiatives, 2) existing data systems, and 3) priority areas for research partnerships, specifically, how research can contribute to the transformation of how and where Veterans choose to receive their care, inform national policies with an understanding of the economic impact of emerging, technology-assisted approaches to access, and set a new precedent for care delivery. 2. Break Out Sessions (90 minutes): Following the didactic component we will facilitate a break-out session in which the audience will work in small groups (8-10) to consider a specific potential research area. Audience members will be encouraged to join groups that address either current projects they are engaged in, or areas that represent potential future projects and networking to identify potential research partners will be encouraged. Potential topics include: • Bridging the digital divide: As we increase virtual care how can we address demographic and regional disparities in information and communication technologies? • Research and the Mission Act: The Mission act aims to not only expand Veteran access to community care, but makes finding solutions to "underserved facilities" a priority and mandates quality measures for VA and community care services. How do we define, identify, and effectively partner with underserved facilities? How do we establish quality measures for new virtual care modalities? • Reaching outside the VA: How do we engage with Non-VA partners (DOD, VSOs, and private community settings)? • "Build or Buy": Should we pay for more community care or should we develop more telehealth resources? How can we compare cost and outcomes to inform these decisions? • Transitioning to Cerner: How will Cerner support virtual care information and data? Can the transition be leveraged to facilitate telehealth? • Application development within the VA: What are the barriers, challenges and needed infrastructure for developing virtual applications within the VA? • Exploring emergent technologies: Can we utilize fitness trackers, smartphones, and connected home devices (e.g. Alexa, Siri, etc.) to develop new virtual care platforms and modalities such as touchless monitoring? • Additional critical research questions identified by the attendees. Forum leaders will be available to provide input and feedback to each group and each group will have a facilitator to take notes and focus the discussion. Groups will identify 2-3 specific potential research priorities for which they will identify, address, and record the following: 1) Specific Research Question, 2) Plan for Identifying and Engaging Clinical and Operational Partners, 3) Plan for Engaging Veterans, 4) Appropriate Research Methods, 5) Dissemination Plan, 6) Challenges 3. Discussion (20 minutes): Discussion of research challenges that could be addressed through partnership with program offices (e.g., centralized resources for data access, analytic resources, information about technology advances). 4. Reporting Back (20 minutes): Program leadership will report back to the group the brainstormed research questions and projects that align with their program office priorities. 5. Wrap-up/General Discussion (25 minutes)

Results:

Implications:
HSRD researchers and representatives from VA program offices that are interested in the intersection of patient-facing technology and access to care.

Impacts:
We will provide HSR&D: 1) List of research questions and potential projects for specific patient-facing technologies, 2) List of research questions and potential projects including specific partnerships, challenges, and the anticipated impact on VA policies and practices, 3) Opportunities to enhance research through centralized support and resources from program offices