Abstract

Background: VA is a leader in virtual care (VC), a term that covers over 60 patient- and team-facing mobile applications, an online patient portal, and numerous telehealth services. There is incredible potential for VC to support chronic disease management, such as that for chronic obstructive pulmonary disease (COPD). COPD is a leading cause of mortality and substantially more prevalent in Veterans than civilians. Use of VC in COPD has shown significant improvements in morbidity and hospitalizations. However, VC services can only support COPD management if they are adopted. Veterans are not currently taking full advantage of the power of VC, largely because neither patients nor the healthcare team are aware of the available options. My CDA will develop a strategy to address this gap. This CDA will equip me with the necessary training to tackle this and other barriers as I develop into an independent health services researcher with expertise in the development and implementation of VC services to support chronic disease management. Significance/Impact: As part of the MISSION Act, VA prioritizes providing “any care anywhere” and emphasizes the value of VC in achieving this goal. This prioritization is echoed in the VA Office of Connected Care’s 2021-2025 Strategic Plan which aims to enhance Veteran engagement with VC and empower the workforce to deliver VC. Aligned with these priorities, the proposed study will develop and pilot an innovative, patient-centered implementation strategy aimed at addressing patient- and healthcare team-facing barriers to adopting VC for COPD. The proposed work will yield knowledge as to whether this strategy is feasible and effective for engaging patients, encouraging patient-team decision making, and expanding access to VC services for patients who want to use them. This knowledge will be transferable across other chronic conditions by adapting the educational content pertaining to the VC services for other chronic conditions. An effective strategy to support VC adoption has potential for enormous impact on the lives and health of Veterans. Innovation: This is the first study to leverage VA’s Annie, a free and easily accessible short message service (SMS) texting platform, to deliver empowering educational content to support Veterans in navigating the multitude of VA VC services. Specific Aims: We will generate information about barriers and facilitators healthcare team members (Aim 1) and Veterans with COPD (Aim 2a) face regarding adoption of VC. Aim 2b will develop a multicomponent implementation strategy, referred to as VC-OPTIONS (Virtual Care for Chronic Obstructive Pulmonary Disease Adoption Support) to support adoption of VC for COPD management. Aim 3 will pilot the VC-OPTIONS implementation strategy to assess feasibility and acceptability and gather preliminary effectiveness data to inform a larger hybrid effectiveness-implementation trial. Methodology: In Aim 1a I will administer a survey to clinical team members to understand current awareness and use of VC and identify persons to interview in Aim 1b, which will use qualitative interviews to identify barriers and facilitators to supporting Veteran adoption of VC. Aim 2a will identify patient-facing barriers to VC adoption. This aim will also use a participatory design process to develop and refine educational content to be delivered via Annie as the core component of VC-OPTIONS. Aim 2b will develop and refine the components of VC-OPTIONS. Aim 3 will pilot the implementation strategy for feasibility and acceptability and gather preliminary effectiveness data on VC awareness and adoption. Next Steps/Implementation: The implementation strategy will be evaluated in a hybrid type 2 effectiveness- implementation trial in a subsequent IIR. Findings will be communicated to VA operational partners to inform the future of VC adoption initiatives. Knowledge from this CDA will prepare me to develop studies focused on supporting uptake of VC in other prevalent chronic conditions and overcoming other barriers to VC adoption.

NIH Reporter Project Information: https://reporter.nih.gov/project-details/10632468


PUBLICATIONS:

Journal Articles

1. Robinson SA, Shimada SL, Sliwinski SK, Wiener RS, Moy ML. Stakeholder Perceptions of a Web-Based Physical Activity Intervention for COPD: A Mixed-Methods Study. Journal of clinical medicine. 2023 Sep 29; 12(19).