2023 HSR&D/QUERI National Conference

4141 — Promoting Proactive Integrated Use of Virtual Healthcare Resources in PACT: Examining Implementation Strategies and Use Patterns Pre- and Post- COVID

Lead/Presenter: Jolie Haun,  James A. Haley Veterans Hospital
All Authors: Haun JN (James A. Haley Veterans Hospital), Melillo, C (James A. Haley Veterans Hospital) Panaite, V (James A. Haley Veterans Hospital) Venkatachalam, HH (James A. Haley Veterans Hospital) Fowler, C (James A. Haley Veterans Hospital) Alman, AC (James A. Haley Veterans Hospital) Lapcevic, W (James A. Haley Veterans Hospital) French, DD (Center of Innovation for Complex Chronic Healthcare)

Proactive integrated virtual healthcare resource (VHR) use can improve efficiency, maximize capacity for delivering care and improve patient outcomes. The purpose of this HSRandD study was to inform the VHA’s system-wide implementation efforts to increase proactive integrated VHR use among Patient Aligned Care Teams (PACT). The objectives were to: (1) examine PACT VHR use; (2) describe PACT member self-reported perceptions and VHR use pre- and post-COVID-19; (3) describe PACT VHR use patterns within a large VA medical center pre- and post-COVID-19 using secondary data sources; (4) triangulate data to identify targeted implementation strategies to promote proactive integrated VHR use in PACT.

In this mixed-method participatory hybrid study, a cross-sectional sample of PACT members (n = ?65), at a large VA facility with five outpatient clinics, participated in focus group, follow-up interview (n = ?16), baseline survey (N = 62), and follow-up survey (or follow-up only) (N = 85). Subject matter experts (n = ?15) participated in informant interviews. A longitudinal, pre-post within-subjects design was used for self-report survey data. For secondary VHR use data, data from 106 individual PACTs were extracted from VHA databases between September 2019 to September 2020. Using longitudinal data, mixed effect models were used to compare slopes pre- and post- COVID-19 onset.

Data gleaned limited evidence of proactive integrated VHR use in PACT. Relevant facilitators and barriers, and recommendations for PACT-specific implementation strategies were identified. Respondents reported issues with knowledge, access, and functionality. Participants identified the need for best practices that are specific to complex care tasks and performance measures. Survey data and qualitative findings describing VHR use, and factors that influence use, were convergent. Most (83%) felt prepared to transition to virtual care during the pandemic. Use of My HealtheVet, Telehealth, and mobile apps showed a significant increase (22.7%; 31.1%; 48.5%). This project produced a data extraction blueprint, designed to track VA VHR use, leveraging secondary data sources. Data suggest utilization rates increased significantly for SM and telehealth visits after COVID-19 onset, with a temporary spike in online prescription refill use.

Currently PACT VHR use is largely reactive and not optimally integrated. Education, awareness building, and infrastructural support are warranted. Dissemination of best practices specific to complex care tasks and performance measures is needed. Providers report the ability to adapt and provide virtual care, when resources, support, and infrastructure are in place. Secondary data sources provide an objective measure to monitor VHR use and can inform healthcare delivery changes within the VA system over time.

Learning health systems are leveraging VHR to maximize information exchange, clinical decision support and patient engagement. VHR are valuable tools, especially during COVID-19, to support continuity and access to care, but targeted implementation strategies are needed to increase awareness and uptake of proactive integrated VHR use. Best practices to achieve performance measures and complex coordinated tasks across the care continuum is needed. Cultural change through education and dissemination of best practices of proactive integrated use across the healthcare continuum is needed to create a culture of VHR super users.