Implementation of VA's medical home model is intended to enhance the patient-centeredness of care delivery, particularly within its primary care settings. Technology can facilitate coordination, communication, and patient education, and is a critical component of VA's medical home model. The VA has made a strong investment in technologies to support "patient-mediated" information sharing, with the goal of promoting engagement and facilitating care coordination. The Blue Button (BB), a feature of the My HealtheVet (MHV) web portal, enables Veterans to create an electronic file of self-entered information and extracts from their VA medical record. Despite the potential of BB to support information sharing, its use remains low. Evidence suggests that clinical team member endorsement of technologies like BB is important to their uptake among patients, yet few resources exist to support clinical staff in this kind of work. In this project, we used multiple data sources to understand current perceptions and uses of BB and other VA information sharing technologies among Patient-Aligned Care Team (PACT) members and applied these insights to design a toolkit to promote their adoption in VA primary care settings.
Working within VISN 12, the overarching objective of this study was to increase use of the BB feature of MHV and other information sharing technologies in VA primary care settings, thus furthering the integration of these tools within the PACT model.
Aim 1: To develop an empirically-based toolkit intended for use by PACT members and designed to enhance use of BB and other information sharing technologies
Aim 2: To pilot test the toolkit among a subset of VISN 12 PACT members
We pursued the aforementioned aims through a mixed method, multi-phase design. Phase one was formative. We conducted an online survey (N=228; response rate=20%) and follow-up semi-structured, audio-recorded telephone interviews (N=20) with PACT members in VISN 12. Analysis of survey data was descriptive; interviews were coded by multiple team members following rapid assessment procedures. Survey and interview findings were used to inform an iterative process based on principles articulated by the Agency for Healthcare Research and Quality (AHRQ) for toolkit development. Prototypes of each toolkit item were drafted, reviewed by operational partners, refined, and reviewed again. Once the toolkit and its components were finalized, it was distributed to PACT members for pilot testing at two VISN 12 facilities.
Survey findings revealed that about half of respondents (53%) had heard of the VA BB. Over 60% of respondents reported that they rarely or never discussed the BB or the contents of BB reports with patients; however, 56% agreed or strongly agreed that they would be supportive of efforts to increase use of BB in primary care at their facility. Interviews revealed very similar themes as were found in the survey. Interviewees reported understanding of the broader MHV portal but considerably less understanding of BB and how it could fit within the context of their daily clinical work. Interestingly, survey respondents agreed that giving Veterans the opportunity to access their clinical progress notes through the VA BB would help patients to understand their health and medical conditions better; however, interviewees articulated various concerns about Veteran access to notes, including misinterpretation, misunderstanding, and disagreement with note information. Survey respondents and interviewees both saw value in having a variety of toolkit resources available to them, including: a list of BB data classes and wait times, comparisons between the VA Health Summary (CCD) and customizable BB reports, and other navigation and decision aids to select among available VA information sharing tools. We used the interviews to talk more in depth about toolkit items that would be useful and were able to construct a list of preferred resources. Using these findings, we engaged in an iterative process to design 23 separate tools that we subsequently organized in three categories: (1) Awareness tools; (2) Understanding tools; and (3) Go-deeper tools. Prototypes were developed for tip sheets explaining how to use BB, BB data class summaries, clinical vignettes, and decision support tools mapping clinical situations and patient needs to different information sharing technologies. Our results from pilot testing are important for addressing the scalability of the toolkit for broader dissemination.
VA's PACT model and the MHV patient portal both have the potential to improve the health and healthcare experiences of our nation's Veterans. To achieve this potential, however, the features of MHV must be meaningfully integrated into PACT. Identifying effective approaches to enhance the use of information sharing technologies like the BB is a goal articulated in VA's Blueprint for Excellence. Toolkits of the kind we designed in this study are a necessary resource for PACT members if they are expected to endorse use of such technologies with the Veterans they serve. We expect that the toolkit components will help to demonstrate the value of BB to primary care teams-an important first step towards broader implementation. Our operational partners are also considering how they can further disseminate the toolkit across VA facilities and repurpose its component parts for presentation in other formats.
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- Richardson LM, Luger T, Hill J, Nazi K, Gordon H, Whittle JC, Weaver FM, McInnes DK, Simon SR, Smith BM, Hogan TP. Implementing Blue Button in VA Primary Care Settings: Survey and Interview Findings. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2015 Apr 25; San Antonio, TX.