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INV 20-111 – HSR Study

INV 20-111
Telehealth for Acute Care in VA
Anita A Vashi, MD MPH MHS
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: October 2020 - March 2022


Project goals: In partnership with VA's National Emergency Medicine Program Office (EM-PO) and the VA Telehealth/Office of Connected Care, we propose to design, implement, and test innovative virtual solutions to rapidly triage and meet urgent care (UC) needs of Veterans. Using innovative solutions developed by public- private partnerships, our proposed program, the Virtual Urgent Care Network (VUCN), will seek to provide on- demand evaluation and treatment of unscheduled, urgent conditions. Our goal is to make health care accessible to those living in rural communities and make services more readily available for people with limited mobility, time, or transportation options. The objectives of this Phase 1 proposal are to: (1) conduct an environmental scan to identify strengths, weaknesses, opportunities and threats related to providing virtual UC services; (2) assess the feasibility, acceptability, and adoption of three specific virtual health strategies: e-visits, self-service options, and novel spaces (e.g., Walmart); and (3) design a VUCN program and a corresponding evaluation plan. Long-term Aim of Phase 2: If selected, we would use our Phase 1 plan to conduct a hybrid, type II large-scale implementation evaluation. Additionally, we would support our partners, the EM-PO, in their implementation of the VUCN. Specifically, our evaluation would seek to: (1) assess variation in implementation across settings, clinicians, and patient subgroups; (2) determine implementation outcomes (i.e., feasibility, fidelity, acceptability, and sustainability); (3) examine clinical outcomes (i.e., efficiency, safety, effectiveness, timeliness, and utilization); and (4) understand patient, provider, and staff-level barriers and facilitators. Innovation: The EM-PO is highly motivated to build on existing momentum and create a VUCN. The timing of the MISSION Act implementation and launch of the VA's Accessing Telehealth through Local Area Station (ATLAS) program have been instrumental in attracting new partners (VA Telehealth/Office of Connected Care and Office of Community Care). VA Telehealth will partner with us to identify how we can modify/adopt existing virtual solutions that are currently used in other sectors (i.e., primary care and mental health) to provide UC triage, evaluation, or treatment. As the ATLAS program continues to expand to include American Legion posts and Walmart spaces, we have the unique opportunity to be the first to test and assess feasibility and acceptability of incorporating this innovative strategy in our VUCN. Impact: Virtual UC services, from e-visits to use of novel spaces, can substantially improve timely access to UC services for the 3.2 million rural Veterans who live over an hour away from a VA ED or UC center. Since the UC benefit under the MISSION Act became available in June 2019, the Office of Community Care estimates there have already been 90,000 visits to non- VA UC centers. This estimate is predicted to rise dramatically over time and suggests existing VA acute care services are not meeting Veteran demand for UC services. If existing VA resources and staff can be used to provide virtual UC needs, VA can continue to be the place Veterans turn to when they have an unscheduled urgent issue. Phase 1 accomplishments: Key milestones for Phase 1 include: (1) using VA data to examine UC utilization and performing a needs assessment; (2) writing and disseminating an environmental scan; (3) convening a stakeholder advisory group to define the goals, target populations, and objectives of the proposed VUCN program; and (4) designing the VUCN program and evaluation plan with partner input. Next steps: VUCN design, implementation, and evaluation will require collaboration between providers, researchers, private industry and VA policymakers. We will reach out to additional VA partners including the Office of Rural Health and VA Clinical Resource Hubs. Phase 1 also provides an opportunity to connect with private sector stakeholders with expertise in the areas of: (1) implementing teleurgent care programs (Kaiser, Teledoc, UnitedHealthcare); (2) creating self-service technologies (Bright.MD, CirrusMD, HealthTap); and (3) creating/hosting novel virtual spaces (Walmart, Philips).

External Links for this Project

NIH Reporter

Grant Number: I01HX003171-01

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None at this time.

DRA: Health Systems
DRE: TRL - Applied/Translational, Technology Development and Assessment, Treatment - Implementation
Keywords: Care Coordination, Care Management Tools, Telemedicine/Telehealth
MeSH Terms: None at this time.

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