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Cordasco KM, Zuchowski J, Hamilton A, Knapp H, Saavedra JO, Altman L, Washington DL. Lessons Learned in Implementing VA’s Comprehensive Women’s Health SCAN-ECHO Program. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 8; San Diego, CA.
Research Objective: Although women are a rapidly growing segment of Veterans Administration's (VA) patient population, many VA primary care providers' (PCPs) have small female caseloads, making it challenging for them to build and maintain their women's health (WH) knowledge and skills. As part of VA's SCAN-ECHO (Specialty Care Access Network - Extension for Community Healthcare Outcomes) program, we implemented a Comprehensive WH SCAN-ECHO program with the objective of building and maintaining WH PCPs' knowledge in evaluation and management of conditions specific to, more common in, or with special considerations for women (e.g., gynecology, breast issues, depression). The program consisted of monthly group PCP-specialist clinical tele-videoconferencing sessions in which PCPs obtained virtual specialist case consultation and received serial patient-based education. PCPs submitted consultation requests on patients for whom they wanted diagnostic and/or therapeutic management advice. During sessions, the specialist at a "hub" facility engaged PCPs at multiple "spoke" sites in real-time case discussions, giving recommendations and citing underlying evidence. A brief didactic was also included. Continuing Medical Education credit was provided. Sessions were held at noon in the hosting site's time zone; 14 sessions were conducted over 16 months. Study Design: We used participation logs, participant surveys, semi-structured interviews, and stakeholder meeting field notes. Logs assessed number of participants in each session and distribution by VA healthcare system (HCS). Surveys were administered by internet and responses tabulated. Semi-structured interviews were transcribed and content was summarized by topic. Stakeholder meeting field notes were reviewed. Setting and Participants: WH PCPs across three VA HCS Principal Findings: Sixty-five PCPs in three HCS participated in one or more sessions, averaging 11 participants per session. Participation was much higher in the one HCS where providers had time protected from their clinic responsibilities (rather than meeting over lunch). From 58 surveys, 45 (78%) strongly agreed and 7 (12%) agreed, that the information provided in the session would influence their patient care. Of these, respondents indicated the information would change their: diagnostic plans (74%); treatment plans (83%); prescription of medications (58%); and overall interactions with patients (68%). Among 10 interviewees, all reported finding SCAN-ECHO useful for building and maintaining their WH knowledge. However, all interviewees also reported that the session being conducted during their lunch hour limited their consistent participation, with morning clinics often running late and participants having competing clinical, administrative, educational and personal priorities for that time. Interviews and key stakeholder discussions revealed that rotating specialists and topics across the breadth of WH, although appealing in its comprehensiveness, limited submission of cases as PCPs were unlikely to have active case-based questions coincident with the monthly specialist's area of expertise. Conclusions and Implications for Policy or Practice: VA's SCAN-ECHO program is a promising modality for building and maintaining PCP knowledge on WH topics and positively influencing patient care. However, PCPs receiving time protected from clinical responsibilities is essential for robust and consistent participation. Further, narrowing in on a consistent WH area, such as gynecology, although sacrificing the program's comprehensiveness, may facilitate PCPs having active cased-based questions for sessions.
