Accelerating Implementation of VA Virtual Care
Virtual care is a critical component of VHA’s efforts to expand Veterans’ access to care and to improve population health. Virtual care is defined as clinical interactions with clinicians that do not require patients and clinicians to be in the same room at the same time. While VHA relies on a developed telehealth infrastructure to facilitate patient communication with healthcare teams, there are disparities in technology use and access, particularly among Veterans who are older, living in rural areas, or of lower socioeconomic status. Additional research studies and improvement science projects are needed within VHA to improve care delivery via virtual care. In December 2019, HSR&D investigators hosted a four-hour Think Tank, Accelerating Implementation of Virtual Care in VHA Practice, to: a) examine current virtual care research and practice; b) consider challenges to virtual care research across VA; c) discuss novel approaches to using and evaluating virtual care; and d) assess perspectives of virtual care from a variety of stakeholders. Think Tank attendees (n = 18) included VHA stakeholders such as operations partners (e.g., Office of Rural Health, Office of Nursing Services, National Center for Health Promotion and Disease Prevention, Diffusion of Excellence), clinicians (e.g., physicians, nurses, psychologists, physician assistants), and health services researchers.
- Think Tank attendees identified an initial list of 15 potential priorities and narrowed these down to four: 1) scaling evidence-based practices, 2) centralizing virtual care, 3) creating high-value care within VHA with virtual care, and 4) identifying appropriate patients for virtual care.
- The Think Tank took an important step in setting a partnered research agenda to optimize the use of virtual care within VHA. In doing so, investigators learned that:
- Clarifying who “owns” virtual care is essential to its success, and
- Creating a faster pipeline of inception to implementation can help to align aims and timelines for research and operations.
- The success and widespread use of virtual care depends upon implementing innovative processes, encouraging their uptake by clinicians and Veterans, and developing a useful evidence base so stakeholders can make appropriate decisions. By quickly identifying and spreading successful projects, VHA can positively affect the health care delivered to Veterans.
- Although Veterans and VHA stakeholders were invited, several key individuals were unable to attend; however, the Think Tank did include national, regional, and local stakeholders with virtual care decision-making responsibilities. VA’s response to the COVID-19 pandemic has demonstrated our ability to rapidly expand virtual care, but recommendations on how to optimize that care remain relevant.
Authors are part of HSR&D’s Center of Innovations to Accelerate Discovery and Practice Transformation (ADAPT) in Durham, NC.
Lewinski A, Sullivan C, Allen K, et al. Accelerating Implementation of Virtual Care in an Integrated Health Care System: Future Research and Operations Priorities. Journal of General Internal Medicine. January 26, 2021; online ahead of print.