JGIM Supplement Highlights VA's Unique Advances in Virtual Care
BACKGROUND:
VA has developed and adopted an ever-evolving suite of technologies to facilitate remote monitoring and disease management, enhance Veteran self-management, support Veteran communication with their care team, and host real-time remote clinical appointments across disparate locations. Led by the Office of Connected Care (OCC), VA has adopted the term “virtual care” to refer to such technologies, with the goal of enhancing the accessibility, capacity, quality, and experience of VA healthcare for Veterans, their families, and caregivers, wherever they are located. The COVID-19 pandemic prompted the rapid expansion of virtual care and the establishment of VHA’s Virtual Care Consortium of Research (CORE) in 2020. In 2022, the Virtual Care CORE held a State-of-the-Art (SOTA) conference to identify research priorities that: 1) address virtual care access disparities, 2) enhance Veteran engagement with virtual care, and 3) define and improve outcomes influenced by virtual care. Since the SOTA, the Virtual Care CORE has disseminated research priorities identified at the conference to its national network of investigators and to VA more broadly. Sponsored by VA Health Systems Research, this supplemental issue of the Journal of General Internal Medicine (JGIM) describes opportunities to advance VA virtual care research and presents a collection of articles reporting on novel virtual care research and evaluation initiatives across the healthcare system. Among the included articles:
- Leung et al., assess the use of video-based primary care among Veterans who experienced homelessness before and during the pandemic and describe the dramatic increase in Veterans who had a video-based visit in primary care.
- Javier et al., describe persistent racial-ethnic disparities in the context of telehealth specialty pain care during the COVID-19 pandemic, advocating for additional research to examine how such disparities could be reduced moving forward.
- O’Shea et al., found that Veterans who had at least one video visit were more likely to have subsequent emergent care and hospitalization; this also included hospitalization for ambulatory care–sensitive conditions.
- Gujral et al., found that sites with Clinical Resource Hubs to facilitate national delivery of care via telehealth had higher rates of delivering telephone primary care visits and lower rates of emergent care and hospitalization during the pandemic than sites without a hub.
- Robinson et al., present survey data regarding Veterans’ adoption of digital health devices (DHDs), finding that the vast majority of Veterans in their cohort were current or past users of DHDs, such as lifestyle monitoring and self-management devices.
IMPLICATIONS:
- VA was among the first healthcare systems to implement virtual care technologies, and millions of Veterans have since benefitted from virtually-delivered services and support. As a Learning Health System, VA has been able to leverage partnered research and evaluation approaches to advance the quality of virtual care delivered nationwide. The rich data available to VA researchers have facilitated large-scale, rigorous studies that are not feasible elsewhere, many of which are featured in this JGIM special issue.
