MyVA and the Department of Veteran's Affairs (VA) Blueprint for Excellence articulate a vision for delivering Veteran-centered care leveraging information technologies, analytics, and new models of health care delivery. The Veterans Health Administration (VHA) is currently expanding integration efforts of virtual medical modalities [VMM (i.e., My HealtheVet, Vet Link kiosks, telehealth, mobile applications)] to increase consumer use and optimize function. Integrated use of VMM can increase individual and system efficiency, maximize resources and enhance patient outcomes. This proposal is responsive to the HSR&D solicitation for health services research on provider behavior (HX-16-009) in its goal to increase integrated use of VMM by patient aligned care teams (PACT), using novel PACT-focused implementation strategies.
Our short-term goal is to develop innovative PACT team implementation strategies to increase integrated use of VMM. Long-term, this research will inform regional and national implementation efforts to promote integrated use of VMM in the ambulatory care setting. The research aims are to: (1) Identify characteristics of PACT team members that impact VMM use among early- and late- adopters; (2) Develop implementation strategies to promote PACT team adoption of VMM; and (3) Evaluate local implementation of PACT focused strategies to promote VMM adoption.
A community-based participatory research approach using concurrent mixed-methods will be used to conduct this three-year implementation study. This study design overcomes limitations of previous research identified in the HSR&D targeted solicitation for health services research on provider behavior. In Phase 1 (Aim1) focus groups (n=67) with questionnaires and follow-up individual interviews (n=20) were conducted with PACT team members and extended team members. Based on Phase 1 findings the team added expert informant interviews (n=15) to further inform the proactive integrated use of VMM. In Phase 2 (Aim 2) the team is collaborating with VA eHealth researchers and operational partners to conduct an environmental scan and collect current and emerging provider focused implementation tools and resources. This activity is currently underway. The team will then conduct a gap analysis based on Aim 1 findings to determine what implementation strategies and content need to be adapted or developed, and adapt/develop necessary content and convene a PACT expert panel to evaluate resultant content. In Phase 3 (Aim 3) a local implementation of PACT-focused strategies to promote integrated use of VMM will be evaluated using pre- and post- questionnaire surveys, brief structured interviews, and secondary data analysis with PACT team members (n=63).
Preliminary findings from the Phase I (Aim 1) suggest PACT team members largely rely on secure-messaging and have a limited knowledge of potential of other VMM or for the proactive integrated use of VMM. As such, the research protocol was amended to additionally recruit up to 15 expert informants to conduct a brief 30-minute interview to get at the current and potential integrated use of virtual medical modalities. This additional work will inform implementation strategy development in Phase 2.
This research supports the MyVA vision and Connected Care Office strategic plan to increase the integrated use of VMM to enhance delivery of proactive patient-driven care. This research is timely in its alignment with the current re-organization and redesign efforts of VMM within the VA. This study will produce the first protocol to objectively evaluate integrated VA VMM use employing secondary data sources. Deliverables will include PACT-driven strategies to support integrated use of VMM in the ambulatory care setting. Integrated use of these modalities will promote personalized, pro-active patient-driven care for Veterans. Data sources will be triangulated to increase the knowledge base of PACT team experiences using VMM and advance implementation science. This research will evaluate locally delivered strategies to support subsequent implementation efforts at regional and national levels.
- Cotner BA, Chavez M, Hathaway W, Melilo C, Nazi KM, Messina W, Haun JN. Rapid Analysis of Strategies to Implement Virtual Medical Modalities (VMM). Archives of physical medicine and rehabilitation. 2018 Oct 1; 99(10):e27.
- Haun J, Chavez M, Hathaway W, Antinori N, Melillo C, Cotner BA, McMahon-Grenz J, Zilka B, Patel-Teague S, Messina W, Nazi K. Virtual Medical Modality Implementation Strategies for Patient-Aligned Care Teams to Promote Veteran-Centered Care: Protocol for a Mixed-Methods Study. JMIR research protocols. 2018 Aug 15; 7(8):e11262.
- Haun JN, Hathaway W, Chavez M, Antinori N, Vetter B, Miller BK, Martin TL, Kendziora L, Nazi KM, Melillo C. Clinical Practice Informs Secure Messaging Benefits and Best Practices. Applied clinical informatics. 2017 Dec 14; 8(4):1003-1011.
Treatment - Implementation, Treatment - Observational, Technology Development and Assessment