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2023 HSR&D/QUERI National Conference Abstract

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4128 — Evaluating the Effectiveness of Routine Screening for Digital Needs Among Rural Veterans

Lead/Presenter: Alicia Cohen,  COIN - Providence
All Authors: Cohen AJ (Center of Innovation in Long Term Services and Supports, VA Providence; Brown University School of Medicine and School of Public Health), Heyworth, L (Office of Connected Care; University of California San Diego Medical School) Russell, LE (Office of Health Equity) Kennedy, MA (Geriatric Research, Education, and Clinical Center, VA Bedford; Boston University School of Medicine) Halladay, CW (Center of Innovation in Long Term Services and Supports, VA Providence) Mitchell, KM (Geriatric Research, Education, and Clinical Center, VA Bedford) Moy, E (Office of Health Equity) Silva, JW (National Social Work Program Office, Care Management and Social Work, Patient Care Services) Cornell PY (Center of Innovation in Long Term Services and Supports, VA Providence; Brown University School of Public Health)

Objectives:
Ensuring access to technology is essential to health equity, particularly in the setting of the COVID-19 pandemic. The Veterans Health Administration (VHA) has launched several initiatives to facilitate access to telehealth services among Veterans, including a national Digital Divide Consult. Through this consult, Veterans without reliable internet access and/or a video-capable device can receive assistance applying for federal internet subsidies or a VA-loaned internet-connected device. Because VHA lacked a way to systematically identify Veterans who would benefit from a Digital Divide Consult, our team developed and integrated digital needs questions into an existing social risk screening and referral initiative, Assessing Circumstances and Offering Resources for Needs (ACORN).

Methods:
We conducted a mixed methods pilot of digital needs screening within ACORN beginning in July 2021. Digital needs questions were developed with input from an interprofessional team in partnership with the VHA Offices of Connected Care, Health Equity, and the National Social Work Program. Questions were refined through cognitive testing with Veterans and piloted within two rural VHA primary care clinics, where PACT social workers routinely screened Veterans as part of an intake assessment. Digital needs assessed included access to a phone, tablet, and/or computer; access to reliable and affordable internet; running out of phone minutes and/or data before the end of the month; interest in assistance setting up a future telehealth visit; and need for help learning to use a device for a telehealth visit. Follow up interviews (n = 8) were conducted with social workers to assess barriers and facilitators to implementing the expanded ACORN screener in clinical practice. Data were analyzed using descriptive statistics and rapid qualitative analysis.

Results:
Of 575 Veterans screened between July 2021-June 2022, 46% reported one or more digital needs. Twenty-two percent reported not having access to any device, 12% lacked reliable and affordable internet, and 9% reported often/sometimes running out of phone minutes and/or data. Eleven percent of Veterans were interested in help setting up a telehealth visit; of those, 56% needed help learning to use a device. Early qualitative findings suggest that PACT social workers felt screening for digital needs was important and gave them information not otherwise included in standard assessments. Barriers were also noted, such as that Veterans in isolated rural and mountainous areas are unable to use the broadband on VA-tablets if they live outside of a cellular network.

Implications:
Screening for digital needs by PACT social workers as part of a broader social needs screening initiative was feasible within rural VHA clinic settings. Nearly half of rural Veterans screened positive for one or more digital needs, including both access (i.e., need for device) and knowledge-related (i.e., education on video visits) needs. PACT social workers supported systematic screening for digital needs to improve identification of Veterans who might benefit from a Digital Divide Consult. They also highlighted unique barriers faced by rural Veterans in accessing telehealth services.

Impacts:
Routine screening for digital needs and bridging the digital divide through provision of resources is a critical step towards ensuring equitable access to care, particularly among rural Veterans.