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Insights from Implementing VA's Comprehensive Women's Health SCAN-ECHO Program

Cordasco KM, Zuchowski J, Hamilton A, Knapp H, Saavedra JO, Altman L, Washington DL. Insights from Implementing VA's Comprehensive Women's Health SCAN-ECHO Program. Paper presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 31; Arlington, VA.


Objective: To implement and assess a comprehensive women's health (WH) SCAN-ECHO program for building and maintaining VA WH primary care providers' (PCPs) knowledge in conditions specific to, more common in, or with special considerations for, women. Methods: Using clinical tele-videoconferencing sessions, PCPs obtained virtual specialist consultation and received serial patient-based education. PCPs submitted consultation requests and during sessions, rotating specialists at the "hub" facility engaged PCPs at multiple "spoke" sites in real-time case discussions, giving recommendations and citing underlying evidence. A brief didactic and continuing medical education credit was included. Fourteen sessions were conducted at noon, Pacific Time, over 16 months. For assessment we used participation logs, participant surveys, semi-structured interviews, and stakeholder meeting field notes. Results: Sixty-five PCPs in three HCS participated in one or more sessions; sessions averaged 11 participants. Participation was much higher in one HCS where providers had time protected from clinic responsibilities. From 58 surveys, 45 (78%) strongly agreed, 7 (12%) agreed, that the information provided would influence their patient care, indicating it would change their: diagnostic plans (74%); treatment plans (83%); prescription of medications (58%); and overall interactions with patients (68%). Among 17 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 consistent participation, with morning clinics often running late and participants having competing 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: 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 protected participation time is paramount to its success. Narrowing to a consistent topic may facilitate PCPs having active cased-based questions. Impacts: The program has been modified to focus on gynecology and providers have protected time to participate. Continued assessment is needed to determine the program's effect on Veteran experience, travel expenses, care quality, and efficiency.

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