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2019 HSR&D/QUERI National Conference Abstract

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4047 — Improving access to care using virtual integrated multi-site patient aligned care teams (V-IMPACT): The provider perspective

Lead/Presenter: Lauren Stevenson,  Louis Stokes Cleveland VAMC
All Authors: Stevenson LD (Louis Stokes Cleveland VAMC), Lee, M (VA Eastern Healthcare System, Aurora, CO), Kenney, R (VA Eastern Healthcare System, Aurora, CO) Moldestad, M (VA Puget Sound Health Care System, Seattle, WA) Sayre, G (Denver-Seattle Center of Innovation (COIN), Denver, CO) Ho, M (VA Eastern Healthcare System, Aurora, CO)

Objectives:
Access to care remains a major health care barrier particularly for rural Veterans. The Veterans Health Administration (VHA) established Virtual Integrated Multisite Patient Aligned Care Teams (V-IMPACT) to improve access for Veterans, particularly in rural areas where staffing providers is challenging. Based on Patient-Aligned Care Team (PACT) principles, V-IMPACT "hubs" provide temporary coverage for primary care (PC) patient panels with multidisciplinary teams to distant sites ("spokes") in a virtual modality.

Methods:
Semi-structured interviews were performed (n = 104) with providers and staff at hub sites (n = 62; V-IMPACT directors, PCPs, program support assistants, pharmacists, and mental health clinicians) and spokes (n = 42; MSAs, nurses, and tele-presenters). The goal was to understand 1) barriers and facilitators; 2) perceived effectiveness, scalability, sustainability and characteristics of Veterans impacted by V-IMPACT; and, 3) provider and perceived patient satisfaction. Deductive and inductive content analysis was conducted to identify themes.

Results:
Overall, hub participants described V-IMPACT as a valuable PC service-delivery method. Spoke participants were sometimes reluctant about a temporary program but felt it provided improved access when their site was short on providers. Participants at hubs and spokes voiced issues with pain management and opioids, including challenges writing opioid prescriptions across state lines. Staff at hubs and spokes felt that V-IMPACT provides the same standard of care as in-person appointments, and improved access to a full PACT. They also identified improvements in care coordination, relationships between providers, and provider satisfaction, as well as successful gap coverage. Program flexibility allowed hubs to adapt V-IMPACT to spokes' needs, including providing partial PACTs (e.g., PCP or Pharmacist only) to assist sites that have some PACT services available. Some hub providers and staff reported wishing V-IMPACT was available permanently.

Implications:
V-IMPACT is a unique, highly adaptable, and valuable method of providing temporary coverage in areas experiencing gaps in services. The V-IMPACT model was adaptable to site specific, and patient needs.

Impacts:
The national V-IMPACT team has identified and shared best methods for implementation of the tele-primary care model of V-IMPACT, which has allowed for rapid uptake across VHA. Further evaluation of V-IMPACT will explore perceptions and experiences of Veteran patients.