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Der-Martirosian C, Hou C, Hovsepian S, Diarra Carter M, Heyworth L, Dobalian A, Leung L. Implementation of Video-Based Care in Interdisciplinary Primary Care Settings at the Veterans Health Administration: Qualitative Study. JMIR Form Res 2024; 8:e52830. [PMID: 38592760 DOI: 10.2196/52830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND With the rapid shift to telehealth, there remains a knowledge gap in how video-based care is implemented in interdisciplinary primary care (PC) settings. OBJECTIVE The objective of this study was to gain an in-depth understanding of how video telehealth services were implemented in PC from the perspectives of patients and interdisciplinary PC team members at the Veterans Health Administration (VHA) 2 years after the onset of the COVID-19 pandemic. METHODS We applied a positive and negative deviance approach and selected the 6% highest (n=8) and the 6% lowest (n=8) video-using PC sites in 2022 from a total of 130 VHA medical centers nationally. A total of 12 VHA sites were included in the study, where 43 PC interdisciplinary team members (August-October 2022) and 25 patients (February-May 2023) were interviewed. The 5 domains from the diffusion of innovation theory and the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework guided the development of the 2 study interview guides (provider and patient). We identified themes that emerged across all interviews that were associated with the implementation of video-based care in interdisciplinary PC settings, using directed-content rapid analysis of the interview transcripts. The analysis was guided by 5 a priori NASSS domains: (1) patient condition or characteristic, (2) technology, (3) adopter system, (4) health care organization, and (5) adaptation over time. RESULTS The study findings include the following common themes and factors, organized by the 5 NASSS domains: (1) patient condition or characteristic-visit type or purpose (eg, follow-up visits that do not require physical examination), health condition (eg, homebound or semihomebound patients), and sociodemographic characteristic (eg, patients who have a long commute time); (2) technology-key features (eg, access to video-enabled devices), knowledge (eg, how to use videoconferencing software), and technical support for patients and providers; (3) adopter system-changes in staff roles and clinical practice (eg, coordination of video-based care), provider and patient preference or comfort to use video-based care, and caregiver's role (eg, participation of caregivers during video visits); (4) health care organization-leadership support and access to resources, scheduling for video visits (eg, schedule or block off digital half or full days), and training and telehealth champions (eg, hands-on or on-site training for staff, patients, or caregivers); (5) adaptation over time-capacity to improve all aspects of video-based care and provide continued access to resources (eg, effective communication about updates). CONCLUSIONS This study identified key factors associated with the implementation of video-based services in interdisciplinary PC settings at the VHA from the perspectives of PC team members and patients. The identified multifaceted factors may inform recommendations on how to sustain and improve the provision of video-based care in VHA PC settings as well as non-VHA patient-centered medical homes.
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Affiliation(s)
- Claudia Der-Martirosian
- Veterans Affairs Greater Los Angeles Healthcare System Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, United States
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA, United States
| | - Cynthia Hou
- Veterans Affairs Greater Los Angeles Healthcare System Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, United States
| | - Sona Hovsepian
- Veterans Affairs Greater Los Angeles Healthcare System Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, United States
| | - Maia Diarra Carter
- Office of Primary Care/Patient Care Services, Veterans Health Administration, Washington, DC, United States
| | - Leonie Heyworth
- Office of Connected Care/Telehealth Services, Veterans Health Administration, Washington, DC, United States
- Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, United States
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA, United States
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, United States
| | - Lucinda Leung
- Veterans Affairs Greater Los Angeles Healthcare System Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, United States
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Agneles, CA, United States
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Hua CL, Halladay CW, Rudolph JL, Celardo C, Heyworth L, Harmon AR, Mills WL, Cornell PY. Trends and geographic differences in social work telehealth utilization. Soc Work Health Care 2024; 63:399-413. [PMID: 38529768 DOI: 10.1080/00981389.2024.2333747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/14/2024] [Indexed: 03/27/2024]
Abstract
We plotted trends in social work telehealth use among Veterans in a U.S. national social work staffing program and examined the relationship between geographic factors (rurality and neighborhood disadvantage) and telehealth use (audio and video) using linear probability models. Social work telehealth use increased among Veterans during the COVID-19 pandemic. There were no geographic differences in telephone telehealth use. Video telehealth use was less common among Veterans in isolated rural areas and among Veterans in highly disadvantaged areas. Outreach efforts can address barriers that Veterans who live in rural and disadvantaged areas may experience in using video telehealth.
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Affiliation(s)
- Cassandra L Hua
- Department of Veterans Affairs (VA) Medical Center, Center of Innovation for Long Term Services and Supports, Providence, Rhode Island
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Christopher W Halladay
- Department of Veterans Affairs (VA) Medical Center, Center of Innovation for Long Term Services and Supports, Providence, Rhode Island
| | - James L Rudolph
- Department of Veterans Affairs (VA) Medical Center, Center of Innovation for Long Term Services and Supports, Providence, Rhode Island
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Caitlin Celardo
- National Social Work Program, Care Management and Social Work Services, Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
- VHA Food Security Office, Washington, DC, USA
| | - Leonie Heyworth
- Office of Connected Care/Telehealth Services, Veterans Health Administration, Washington, DC, USA
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Alita R Harmon
- National Social Work Program, Care Management and Social Work Services, Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
- Gulf Coast Veterans Health Care System, Biloxi, Mississippi, USA
| | - Whitney L Mills
- Department of Veterans Affairs (VA) Medical Center, Center of Innovation for Long Term Services and Supports, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Portia Y Cornell
- Department of Veterans Affairs (VA) Medical Center, Center of Innovation for Long Term Services and Supports, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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Wray CM, Myers U, Slightam C, Dardashti N, Heyworth L, Lewinski A, Kaboli P, Edes T, Trueman K, Zulman DM. Research Priorities to Expand Virtual Care Access for Patients in the Veterans Affairs Health Care System. J Gen Intern Med 2024; 39:14-20. [PMID: 38252237 PMCID: PMC10937889 DOI: 10.1007/s11606-023-08463-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/06/2023] [Indexed: 01/23/2024]
Abstract
The rapid expansion of virtual care is driving demand for equitable, high-quality access to technologies that are required to utilize these services. While the Department of Veterans Affairs (VA) is seen as a national leader in the implementation of telehealth, there remain gaps in evidence about the most promising strategies to expand access to virtual care. To address these gaps, in 2022, the VA's Health Services Research and Development service and Office of Connected Care held a "state-of-the-art" (SOTA) conference to develop research priorities for advancing the science, clinical practice, and implementation of virtual care. One workgroup within the SOTA focused on access to virtual care and addressed three questions: (1) Based on the existing evidence about barriers that impede virtual care access in digitally vulnerable populations, what additional research is needed to understand these factors? (2) Based on the existing evidence about digital inclusion strategies, what additional research is needed to identify the most promising strategies? and (3) What additional research beyond barriers and strategies is needed to address disparities in virtual care access? Here, we report on the workgroup's discussions and recommendations for future research to improve and optimize access to virtual care. Effective implementation of these recommendations will require collaboration among VA operational leadership, researchers, Human Factors Engineering experts and front-line clinicians as they develop, implement, and evaluate the spread of virtual care access strategies.
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Affiliation(s)
- Charlie M Wray
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Section of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | - Ursula Myers
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Mental Health Service Line, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Military Sciences Division, Medical University of South Carolina, Charleston, SC, USA
| | - Cindie Slightam
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | | | - Leonie Heyworth
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, Washington, DC, USA
| | - Allison Lewinski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- School of Nursing, Duke University School of Medicine, Durham, NC, USA
| | - Peter Kaboli
- Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, and Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Thomas Edes
- Office of Geriatrics & Extended Care, Department of Veterans Affairs, Washington, DC, USA
| | - Kevin Trueman
- Department of Veterans Affairs, Independence, OH, USA
| | - Donna M Zulman
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Heyworth L, Shah N, Galpin K. 20 Years of Telehealth in the Veterans Health Administration: Taking Stock of Our Past and Charting Our Future. J Gen Intern Med 2024; 39:5-8. [PMID: 38378981 PMCID: PMC10937874 DOI: 10.1007/s11606-024-08617-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Leonie Heyworth
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, 810 Vermont Avenue, Washington, NW, DC 20420, USA.
| | - Nilesh Shah
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, 810 Vermont Avenue, Washington, NW, DC 20420, USA
| | - Kevin Galpin
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, 810 Vermont Avenue, Washington, NW, DC 20420, USA
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Dhanani Z, Ferguson JM, Van Campen J, Slightam C, Heyworth L, Zulman DM. Adoption and Sustained Use of Primary Care Video Visits Among Veterans with VA Video-Enabled Tablets. J Med Syst 2024; 48:16. [PMID: 38289373 DOI: 10.1007/s10916-024-02035-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
In 2020, the U.S. Department of Veterans Affairs (VA) expanded an initiative to distribute video-enabled tablets to Veterans with limited virtual care access. We examined patient characteristics associated with adoption and sustained use of video-based primary care among Veterans. We conducted a retrospective cohort study of Veterans who received VA-issued tablets between 3/11/2020-9/10/2020. We used generalized linear models to evaluate the sociodemographic and clinical factors associated with video-based primary care adoption (i.e., likelihood of having a primary care video visit) and sustained use (i.e., rate of video care) in the six months after a Veteran received a VA-issued tablet. Of the 36,077 Veterans who received a tablet, 69% had at least one video-based visit within six months, and 24% had a video-based visit in primary care. Veterans with a history of housing instability or a mental health condition, and those meeting VA enrollment criteria for low-income were significantly less likely to adopt video-based primary care. However, among Veterans who had a video visit in primary care (e.g., those with at least one video visit), older Veterans, and Veterans with a mental health condition had more sustained use (higher rate) than younger Veterans or those without a mental health condition. We found no differences in adoption of video-based primary care by rurality, age, race, ethnicity, or low/moderate disability and high disability priority groups compared to Veterans with no special enrollment category. VA's tablet initiative has supported many Veterans with complex needs in accessing primary care by video. While Veterans with certain social and clinical challenges were less likely to have a video visit, those who adopted video telehealth generally had similar or higher rates of sustained use. These patterns suggest opportunities for tailored interventions that focus on needs specific to initial uptake vs. sustained use of video care.
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Affiliation(s)
- Zainub Dhanani
- Department of Health Policy, Stanford University School of Medicine, 290 Campus Dr, Stanford, CA, 94305, USA.
| | - Jacqueline M Ferguson
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - James Van Campen
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
| | - Cindie Slightam
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
| | - Leonie Heyworth
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, Washington, DC, USA
- Department of Medicine, UC San Diego School of Medicine, San Diego, CA, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Ferguson JM, Wray CM, Jacobs J, Greene L, Wagner TH, Odden MC, Freese J, Van Campen J, Asch SM, Heyworth L, Zulman DM. Variation in initial and continued use of primary, mental health, and specialty video care among Veterans. Health Serv Res 2023; 58:402-414. [PMID: 36345235 PMCID: PMC10012228 DOI: 10.1111/1475-6773.14098] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To identify which Veteran populations are routinely accessing video-based care. DATA SOURCES AND STUDY SETTING National, secondary administrative data from electronic health records at the Veterans Health Administration (VHA), 2019-2021. STUDY DESIGN This retrospective cohort analysis identified patient characteristics associated with the odds of using any video care; and then, among those with a previous video visit, the annual rate of video care utilization. Video care use was reported overall and stratified into care type (e.g., primary, mental health, and specialty video care) between March 10, 2020 and February 28, 2021. DATA COLLECTION Veterans active in VA health care (>1 outpatient visit between March 11, 2019 and March 10, 2020) were included in this study. PRINCIPAL FINDINGS Among 5,389,129 Veterans in this evaluation, approximately 27.4% of Veterans had at least one video visit. We found differences in video care utilization by type of video care: 14.7% of Veterans had at least one primary care video visit, 10.6% a mental health video visit, and 5.9% a specialty care video visit. Veterans with a history of housing instability had a higher overall rate of video care driven by their higher usage of video for mental health care compared with Veterans in stable housing. American Indian/Alaska Native Veterans had reduced odds of video visits, yet similar rates of video care when compared to White Veterans. Low-income Veterans had lower odds of using primary video care yet slightly elevated rates of primary video care among those with at least one video visit when compared to Veterans enrolled at VA without special considerations. CONCLUSIONS Variation in video care utilization patterns by type of care identified Veteran populations that might require greater resources and support to initiate and sustain video care use. Our data support service specific outreach to homeless and American Indian/Alaska Native Veterans.
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Affiliation(s)
- Jacqueline M. Ferguson
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Charlie M. Wray
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Section of Hospital MedicineVeterans Affairs San Francisco Health Care SystemSan FranciscoCaliforniaUSA
| | - Josephine Jacobs
- Health Economics Resource CenterVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
| | - Liberty Greene
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Todd H. Wagner
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Health Economics Resource CenterVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
| | - Michelle C. Odden
- Geriatric Research, Education, and Clinical CenterVeterans Affairs Palo Alto Health Care SystemPalo AltoCaliforniaUSA
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Jeremy Freese
- Department of SociologyStanford UniversityStanfordCaliforniaUSA
| | - James Van Campen
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
| | - Steven M. Asch
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Leonie Heyworth
- Office of Connected Care/TelehealthDepartment of Veterans Affairs Central OfficeWashingtonDCUSA
- Department of MedicineUniversity of California, San Diego School of MedicineSan DiegoCaliforniaUSA
| | - Donna M. Zulman
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
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Leung LB, Yoo C, Chu K, O’Shea A, Jackson NJ, Heyworth L, Der-Martirosian C. Rates of Primary Care and Integrated Mental Health Telemedicine Visits Between Rural and Urban Veterans Affairs Beneficiaries Before and After the Onset of the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e231864. [PMID: 36881410 PMCID: PMC9993180 DOI: 10.1001/jamanetworkopen.2023.1864] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
IMPORTANCE Telemedicine can increase access to care, but uptake has been low among people living in rural areas. The Veterans Health Administration initially encouraged telemedicine uptake in rural areas, but telemedicine expansion efforts have broadened since the COVID-19 pandemic. OBJECTIVE To examine changes over time in rural-urban differences in telemedicine use for primary care and for mental health integration services among Veterans Affairs (VA) beneficiaries. DESIGN, SETTING, AND PARTICIPANTS This cohort study examined 63.5 million primary care and 3.6 million mental health integration visits across 138 VA health care systems nationally from March 16, 2019, to December 15, 2021. Statistical analysis took place from December 2021 to January 2023. EXPOSURES Health care systems with most clinic locations designated as rural. MAIN OUTCOMES AND MEASURES For every system, monthly visit counts for primary care and mental health integration specialties were aggregated from 12 months before to 21 months after pandemic onset. Visits were categorized as in person or telemedicine, including video. A difference-in-difference approach was used to examine associations in visit modality by health care system rurality and pandemic onset. Regression models also adjusted for health care system size as well as relevant patient characteristics (eg, demographic characteristics, comorbidities, broadband internet access, and tablet access). RESULTS The study included 63 541 577 primary care visits (6 313 349 unique patients) and 3 621 653 mental health integration visits (972 578 unique patients) (6 329 124 unique patients among the cohort; mean [SD] age, 61.4 [17.1] years; 5 730 747 men [90.5%]; 1 091 241 non-Hispanic Black patients [17.2%]; and 4 198 777 non-Hispanic White patients [66.3%]). In fully adjusted models for primary care services before the pandemic, rural VA health care systems had higher proportions of telemedicine use than urban ones (34% [95% CI, 30%-38%] vs 29% [95% CI, 27%-32%]) but lower proportions of telemedicine use than urban health care systems after pandemic onset (55% [95% CI, 50%-59%] vs 60% [95% CI, 58%-62%]), signifying a 36% reduction in the odds of telemedicine use (odds ratio [OR], 0.64; 95% CI, 0.54-0.76). The rural-urban telemedicine gap was even larger for mental health integration (OR, 0.49; 95% CI, 0.35-0.67) than for primary care services. Few video visits occurred across rural and urban health care systems (unadjusted percentages: before the pandemic, 2% vs 1%; after the pandemic, 4% vs 8%). Nonetheless, there were rural-urban divides for video visits in both primary care (OR, 0.28; 95% CI, 0.19-0.40) and mental health integration services (OR, 0.34; 95% CI, 0.21-0.56). CONCLUSIONS AND RELEVANCE This study suggests that, despite initial telemedicine gains at rural VA health care sites, the pandemic was associated with an increase in the rural-urban telemedicine divide across the VA health care system. To ensure equitable access to care, the VA health care system's coordinated telemedicine response may benefit from addressing rural disparities in structural capacity (eg, internet bandwidth) and from tailoring technology to encourage adoption among rural users.
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Affiliation(s)
- Lucinda B. Leung
- Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Division of General Internal Medicine–Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles
| | - Caroline Yoo
- Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Karen Chu
- Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, North Hills, California
| | - Amy O’Shea
- Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Nicholas J. Jackson
- Division of General Internal Medicine–Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles
| | - Leonie Heyworth
- Office of Connected Care/Telehealth Services, Veterans Health Administration, Washington, DC
- Department of Medicine, University of California San Diego School of Medicine, San Diego
| | - Claudia Der-Martirosian
- Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, North Hills, California
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Basch C, Ferguson JM, Van Campen J, Slightam C, Jacobs JC, Heyworth L, Zulman D. Overcoming Access Barriers for Veterans: Cohort Study of the Distribution and Use of Veterans Affairs' Video-Enabled Tablets Before and During the COVID-19 Pandemic. J Med Internet Res 2023; 25:e42563. [PMID: 36630650 PMCID: PMC9912147 DOI: 10.2196/42563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/11/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, as health care services shifted to video- and phone-based modalities for patient and provider safety, the Veterans Affairs (VA) Office of Connected Care widely expanded its video-enabled tablet program to bridge digital divides for veterans with limited video care access. OBJECTIVE This study aimed to characterize veterans who received and used US Department of VA-issued video-enabled tablets before versus during the COVID-19 pandemic. METHODS We compared sociodemographic and clinical characteristics of veterans who received VA-issued tablets during 6-month prepandemic and pandemic periods (ie, from March 11, 2019, to September 10, 2019, and from March 11, 2020, to September 10, 2020). Then, we examined characteristics associated with video visit use for primary and mental health care within 6 months after tablet shipment, stratifying models by timing of tablet receipt. RESULTS There was a nearly 6-fold increase in the number of veterans who received tablets in the pandemic versus prepandemic study periods (n=36,107 vs n=6784, respectively). Compared to the prepandemic period, tablet recipients during the pandemic were more likely to be older (mean age 64 vs 59 years), urban-dwelling (24,504/36,107, 67.9% vs 3766/6784, 55.5%), and have a history of housing instability (8633/36,107, 23.9% vs 1022/6784, 15.1%). Pandemic recipients were more likely to use video care (21,090/36,107, 58.4% vs 2995/6784, 44.2%) and did so more frequently (5.6 vs 2.3 average encounters) within 6 months of tablet receipt. In adjusted models, pandemic and prepandemic video care users were significantly more likely to be younger, stably housed, and have a mental health condition than nonusers. CONCLUSIONS Although the COVID-19 pandemic led to increased distribution of VA-issued tablets to veterans with complex clinical and social needs, tablet recipients who were older or unstably housed remained less likely to have a video visit. The VA's tablet distribution program expanded access to video-enabled devices, but interventions are needed to bridge disparities in video visit use among device recipients.
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Affiliation(s)
| | - Jacqueline M Ferguson
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
| | - James Van Campen
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Cindie Slightam
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Josephine C Jacobs
- Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Leonie Heyworth
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth Services, Veterans Health Administration, Washington, DC, United States.,Department of Medicine, University of California San Diego Health System, San Diego, CA, United States
| | - Donna Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
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9
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Walsh C, Sullivan C, Bosworth HB, Wilson S, Gierisch JM, Goodwin KB, Mccant F, Hoenig H, Heyworth L, Zulman DM, Turvey C, Moy E, Lewinski AA. Incorporating TechQuity in Virtual Care Within the Veterans Health Administration: Identifying Future Research and Operations Priorities. J Gen Intern Med 2023:10.1007/s11606-023-08029-2. [PMID: 36650326 PMCID: PMC9845020 DOI: 10.1007/s11606-023-08029-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The Covid-19 pandemic dramatically changed healthcare delivery, driving rapid expansion of synchronous (i.e., real-time) audio-only and video telehealth, otherwise known as virtual care. Yet evidence describes significant inequities in virtual care utilization, with certain populations more dependent on audio-only virtual care than video-based care. Research is needed to inform virtual care policies and processes to counteract current inequities in access and health outcomes. OBJECTIVE Given the importance of incorporating equity into virtual care within the Veterans Health Administration (VHA), we convened a Think Tank to identify priorities for future research and virtual care operations focused on achieving equitable implementation of virtual care within the VHA. METHODS We used participatory activities to engage clinicians, researchers, and operational partners from across the VHA to develop priorities for equitable implementation of virtual care. We refined priorities through group discussion and force-ranked prioritization and outlined next steps for selected priorities. KEY RESULTS Think Tank participants included 43 individuals from the VHA who represented diverse geographical regions, offices, and backgrounds. Attendees self-identified their associations primarily as operations (n = 9), research (n = 28), or both (n = 6). We identified an initial list of 63 potential priorities for future research and virtual care operations. Following discussion, we narrowed the list to four priority areas: (1) measure inequities in virtual care, (2) address emerging inequities in virtual care, (3) deploy virtual care equitably to accommodate differently abled veterans, and (4) measure and address potential adverse consequences of expanded virtual care. We discuss related information, data, key partners, and outline potential next steps. CONCLUSIONS This Think Tank of research and operational partners from across the VHA identified promising opportunities to incorporate equity into the design and implementation of virtual care. Although much work remains, the priorities identified represent important steps toward achieving this vital goal.
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Affiliation(s)
- Conor Walsh
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA. .,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Caitlin Sullivan
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Hayden B Bosworth
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,School of Nursing, Duke University, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sarah Wilson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer M Gierisch
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kaitlyn B Goodwin
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Felicia Mccant
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Helen Hoenig
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Physical Medicine & Rehabilitation Service, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Leonie Heyworth
- Office of Connected Care/Telehealth, Department of Veterans Affairs Central Office, Washington, DC, USA.,Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Carolyn Turvey
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.,Office of Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA, USA
| | - Ernest Moy
- Office of Health Equity, Veterans Health Administration, Washington, DC, USA
| | - Allison A Lewinski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,School of Nursing, Duke University, Durham, NC, USA
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10
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Cannedy S, Leung L, Wyte-Lake T, Balut MD, Dobalian A, Heyworth L, Paige NM, Der-Martirosian C. Primary Care Team Perspectives on the Suitability of Telehealth Modality (Phone vs Video) at the Veterans Health Administration. J Prim Care Community Health 2023; 14:21501319231172897. [PMID: 37170906 PMCID: PMC10184255 DOI: 10.1177/21501319231172897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Telehealth has the potential to improve access and timeliness of care, enabling primary care teams to deliver hybrid (virtual/in-person) services that will likely extend beyond the COVID-19 pandemic. To optimize its use and sustainability, it is imperative to understand how primary care teams perceive the suitability of telehealth services, including appropriate choice of mode (telephone or video). However, there is limited research on providers' decision-making processes surrounding telehealth use in primary care, including whether to use telephone or video, which this VA-focused study addresses. We examined how primary care (PC) team members determine whether to use telehealth and the mode of delivery, in the care of patients. METHODS Qualitative case study that included 15 semi-structured interviews with employees who provided or supported telehealth care at primary care clinics at the Veterans Health Administration. We used a team-based rapid analysis approach to identify experiences using telehealth soon after COVID-19's emergence, consisting of the creation of structured summaries of each transcribed interview. The lead author then identified and compiled themes and sub-themes related to the suitability of telehealth in primary care, as well as associated quotes from transcripts. Resulting themes and quotes were reviewed and validated by 2 members of the project team. RESULTS Primary care team members considered several factors when assessing both the suitability of telehealth for appointments, and mode of use. They were largely guided by patient-related factors including patient preferences, specific health issues, and access to technology. Additional considerations centered on team members' personal preferences and factors that supported the wellbeing of the team, such as the flexibility to work from home (work-life balance) and protection from infection. Generally, participants viewed the option of both telephone and video telehealth modalities as useful tools in the care of patients although a few respondents emphasized its inferiority to in-person care. CONCLUSIONS Determining the suitability of telehealth services, including appropriate choice of mode is complex. Its suitability is tied to a variety of factors related to multilevel resources, preferences, and timing. When appropriate, telehealth should be considered a useful tool in the care of patients and for employee well-being.
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Affiliation(s)
- Shay Cannedy
- US Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Lucinda Leung
- US Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- University of California Los Angeles, Los Angeles, CA, USA
| | - Tamar Wyte-Lake
- US Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Michelle D Balut
- US Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Aram Dobalian
- US Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- The Ohio State University, Columbus, OH, USA
| | - Leonie Heyworth
- Veterans Health Administration, Washington, DC, USA
- University of California San Diego School of Medicine, San Diego, CA, USA
| | - Neil M Paige
- US Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Claudia Der-Martirosian
- US Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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11
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Connolly SL, Sullivan JL, Lindsay JA, Shimada SL, Heyworth L, Weaver KR, Miller CJ. Factors influencing uptake of telemental health via videoconferencing at high and low adoption sites within the Department of Veterans Affairs during COVID-19: a qualitative study. Implement Sci Commun 2022; 3:66. [PMID: 35725642 PMCID: PMC9207848 DOI: 10.1186/s43058-022-00318-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic dramatically increased the use of telemental health via videoconferencing (TMH-V). While TMH-V has been found to be effective and satisfactory to both patients and providers, little is known regarding factors that influence site-level uptake. We examined facilitators and barriers to TMH-V uptake at higher and lower adoption sites within the US Department of Veterans Affairs (VA). METHODS We conducted twenty-four semi-structured qualitative interviews at four northeastern VA medical centers (two with higher TMH-V adoption and two with lower adoption). Six interviews were conducted per site (one member of mental health leadership, one facility telehealth coordinator/technician, and four mental health providers per site). We performed directed content analysis, guided by the Consolidated Framework for Implementation Research (CFIR), followed by a matrix rating process to rank the degree of influence of each of the 19 included CFIR constructs at the four sites. Positive overall influences, negative overall influences, and differentiators were then identified based on patterns in ratings across sites. RESULTS Five CFIR constructs had positive overall influences across sites: Relative advantage, Patient needs and resources, Relative priority, Knowledge and beliefs, and Self-efficacy. Complexity had a negative overall influence across sites. Four constructs significantly differentiated between higher and lower adoption sites with regards to TMH-V use: Quality, Compatibility, Leadership engagement, and Champions. CONCLUSIONS Several positive overall influences on TMH-V uptake were identified across sites; respondents acknowledged multiple advantages of TMH-V (e.g., convenience), and providers' attitudes towards TMH-V improved as they gained experience. In contrast, complexity was a negative overall influence; TMH-V platforms and processes must be simple and user friendly to promote use. The emergence of Quality, Leadership engagement, and Champions as differentiators speaks to the importance of educating frontline staff and leadership at lower adoption sites about the evidence base demonstrating that TMH-V is high-quality care. Compatibility also emerged as a differentiator; if TMH-V is not easily integrated into provider workflows, uptake will falter. Future work should draw from these findings to develop implementation strategies aiming to increase TMH-V uptake at lower adoption sites, thereby increasing access to high-quality mental health care.
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Affiliation(s)
- Samantha L Connolly
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA. .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Jennifer L Sullivan
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA.,Brown University School of Public Health, Providence, RI, USA
| | - Jan A Lindsay
- Michael E. DeBakey VA Medical Center, HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Stephanie L Shimada
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.,Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Leonie Heyworth
- Veterans Health Administration Office of Connected Care/Telehealth, Washington, D.C, USA.,Department of Health Sciences, University of California San Diego, San Diego, CA, USA
| | - Kendra R Weaver
- Clinical Operations, Veterans Health Administration Office of Mental Health and Suicide Prevention, Washington, D.C, USA
| | - Christopher J Miller
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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12
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Wray CM, Van Campen J, Hu J, Slightam C, Heyworth L, Zulman DM. Crossing the digital divide: a veteran affairs program to distribute video-enabled devices to patients in a supportive housing program. JAMIA Open 2022; 5:ooac027. [PMID: 35991861 PMCID: PMC9053098 DOI: 10.1093/jamiaopen/ooac027] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/22/2022] [Accepted: 04/13/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Evaluate an initiative to distribute video-enabled tablets and cell phones to individuals enrolled in Veterans Health Affairs supportive housing program during the COVID-19 pandemic. Materials and Methods In September 2020, individuals in the Veteran Health Affairs (VA) Housing and Urban Development-VA Supportive Housing (HUD-VASH) program were offered either a video-enabled tablet or cellphone to support their communication and health care engagement needs. We examined sociodemographic and clinical characteristics of device recipients, and compared engagement in in-person, telephone, and video-based visits (categorized as primary care, specialty care, rehabilitation, HUD-VASH, mental health care, and other) for 6 months prior to (March 1, 2020–August 31, 2020) and following (September 1, 2020–July 30, 2021) device receipt. Results In total, 5127 Veterans received either a tablet (n = 4454) or a cellphone (n = 673). Compared to the 6 months prior to device receipt, in the 6 months following receipt, in-person and video engagement increased by an average of 1.4 visits (8%) and 3.4 visits (125%), respectively, while telephone engagement decreased (−5.2 visits; −27%). Both tablet and cellphone recipients had increased in-person visits (+1.3 visits [8%] and +2.1 visits [13%], respectively); while tablet users had a substantially larger increase in video-based engagement (+3.2 visits [+110%] vs. +0.9 [+64%]). Similar trends were noted across all assessed types of care. Discussion Providing video-enabled devices to Veterans in a supportive housing program may facilitate engagement in health care. Conclusions and Relevance VA’s device distribution program offers a model for expanding access to health-related technology and telemedicine to individuals in supportive housing programs. In September of 2020, the Veteran’s Health Affairs (VA) initiated a program to distribute video-enabled tablets and cellphones to Veterans who were enrolled in the Housing and Urban Development-VA Supportive Housing (HUD-VASH) program. The goal of this program was to maintain communication and health care engagement during the pandemic. After receiving either a tablet or cellphone, we compared in-person, telephone, and video-based engagement among the 4454 tablet recipients and the 673 cellphone recipients. We found in the 6 months following receipt, that overall in-person and video engagement increased by an average of 1.4 visits (8%) and 3.4 visits (125%), while telephone engagement decreased (−5.2 visits; −27%). Both tablet and cellphone recipients had increased in-person visits (+1.3 visits [8%] and +2.1 visits [13%], respectively); while tablet users had a substantially larger increase in video-based engagement (+3.2 visits [+110%] vs. +0.9 [+64%]). This study suggests that providing video-enabled devices to Veterans in a supportive housing program may facilitate engagement in health care.
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Affiliation(s)
- Charlie M Wray
- Department of Medicine, University of California, San Francisco, San Francisco, Virginia, USA
- Section of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - James Van Campen
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA
| | - Jiaqi Hu
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA
| | - Cindie Slightam
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA
| | - Leonie Heyworth
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, Washington, District of Columbia, USA
- Department of Medicine, University of California, San Diego, San Diego, California, USA
| | - Donna M Zulman
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
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13
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Connolly SL, Stolzmann KL, Heyworth L, Sullivan JL, Shimada SL, Weaver KR, Lindsay JA, Bauer MS, Miller CJ. Patient and provider predictors of telemental health use prior to and during the COVID-19 pandemic within the Department of Veterans Affairs. Am Psychol 2022; 77:249-261. [PMID: 34941310 PMCID: PMC9309896 DOI: 10.1037/amp0000895] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The current study examined patient and provider differences in use of phone, video, and in-person mental health (MH) services. Participants included patients who completed ≥ 1 MH appointment within the Department of Veterans Affairs (VA) from 10/1/17-7/10/20 and providers who completed ≥ 100 VA MH appointments from 10/1/17-7/10/20. Adjusted odds ratios (aORs) are reported of patients and providers: (a) completing ≥1 video MH appointment in the pre-COVID (10/1/17-3/10/20) and COVID (3/11/20-7/10/20) periods; and (b) completing the majority of MH visits via phone, video, or in-person during COVID. The sample included 2,480,119 patients/31,971 providers in the pre-COVID period, and 1,054,670 patients/23,712 providers in the COVID period. During the pre-COVID and COVID periods, older patients had lower odds of completing ≥ 1 video visit (aORs < .65). During the COVID period, older age and low socioeconomic status predicted lower odds of having ≥ 50% of visits via video versus in-person or phone (aORs < .68); schizophrenia and MH hospitalization history predicted lower odds of having ≥ 50% of visits via video or phone versus in-person (aORs < . 64). During the pre-COVID and COVID periods, nonpsychologists (e.g., psychiatrists) had lower odds of completing video visits (aORs < . 44). Older providers had lower odds of completing ≥ 50% of visits via video during COVID (aORs <. 69). Findings demonstrate a digital divide, such that older and lower income patients, and older providers, engaged in less video care. Nonpsychologists also had lower video use. Barriers to use must be identified and strategies must be implemented to ensure equitable access to video MH services. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Samantha L. Connolly
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Kelly L. Stolzmann
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA
| | - Leonie Heyworth
- Director of Synchronous Telehealth, Veterans Health Administration Office of Connected Care/Telehealth
- Department of Health Sciences, University of California San Diego, San Diego, CA
| | - Jennifer L. Sullivan
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Stephanie L. Shimada
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Kendra R. Weaver
- Senior Consultant, Clinical Operations, Veterans Health Administration Office of Mental Health and Suicide Prevention
| | - Jan. A Lindsay
- Michael E. DeBakey VA Medical Center, HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
- Baylor College of Medicine, Houston, TX
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX
| | - Mark S. Bauer
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Christopher J. Miller
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
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14
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Balut MD, Wyte-Lake T, Steers WN, Chu K, Dobalian A, Ziaeian B, Heyworth L, Der-Martirosian C. Expansion of telemedicine during COVID-19 at a VA specialty clinic. Healthc (Amst) 2021; 10:100599. [PMID: 34999492 PMCID: PMC8616735 DOI: 10.1016/j.hjdsi.2021.100599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
Background COVID-19 rapidly accelerated the implementation of telemedicine in U.S. Department of Veterans Affairs (VA) specialty care clinics. This mixed-methods study was conducted at a VA medical center to understand the use of telemedicine, and the barriers and facilitators to its implementation, in cardiology outpatient clinics. Methods Quantitative analyses modeled monthly trends of telemedicine use over 24-months (March 2019–March 2021) with segmented logistic regression and adjusted for socio-demographic predictors of patient-level telemedicine use. Qualitative interviews were conducted (July–October 2020) with eight cardiology clinicians. Results At the onset of COVID-19, likelihood of telemedicine use was ∼12 times higher than it was pre-COVID-19 (p < 0.001). White (OR = 1.38, 95% CI:1.23–1.54), married (OR = 1.25, 95% CI:1.11–1.40), Veterans with other health insurance (OR = 1.19, 95% CI:1.06–1.35), were more likely to use telemedicine. Veterans with higher health risk factors were less likely (OR = 0.95, 95% CI:0.93–0.97). Facilitators to rapid expansion of telemedicine included prior telemedicine experience; provider trainings; and staff champions. In contrast, lack of technical support and scheduling grids for virtual visits and patient ability/preference served as barriers. Conclusions Findings suggest that once mutable barriers were addressed, the medical center was able to expand its telemedicine efforts during COVID-19. Beyond the pandemic, a hybrid of virtual and face-to-face care might be feasible and likely beneficial for healthcare providers and patients in specialty care. Implications The ability to rapidly transition from in-person to virtual visits can potentially assist with the continuity of care and management of chronic disease during infectious outbreaks and other major disasters that obstruct traditional care models.
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Affiliation(s)
- Michelle D Balut
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, 16111 Plummer St. North Hills, CA, USA.
| | - Tamar Wyte-Lake
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, 16111 Plummer St. North Hills, CA, USA
| | - William Neil Steers
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, 16111 Plummer St. North Hills, CA, USA
| | - Karen Chu
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, 16111 Plummer St. North Hills, CA, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, 16111 Plummer St. North Hills, CA, USA; Division of Health Systems Management and Policy, University of Memphis School of Public Health, 3825 DeSoto Ave. Memphis, TN, USA
| | - Boback Ziaeian
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), U.S. Department of Veterans Affairs, 16111 Plummer St. North Hills, CA, USA; Division of Cardiology, UCLA David Geffen School of Medicine, 10833 Le Conte Ave, Los Angeles, CA, USA
| | - Leonie Heyworth
- Office of Connected Care, Veterans Health Administration (VHA), US Department of Veterans Affairs, 50 Irving St. NW, Washington, DC, USA; Department of Medicine, University of California, San Diego. 9500 Gilman Dr, San Diego, CA, USA
| | - Claudia Der-Martirosian
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, 16111 Plummer St. North Hills, CA, USA
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15
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Der-Martirosian C, Wyte-Lake T, Balut M, Chu K, Heyworth L, Leung L, Ziaeian B, Tubbesing S, Mullur R, Dobalian A. Implementation of Telehealth Services at the US Department of Veterans Affairs During the COVID-19 Pandemic: Mixed Methods Study. JMIR Form Res 2021; 5:e29429. [PMID: 34477554 PMCID: PMC8462492 DOI: 10.2196/29429] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/20/2021] [Accepted: 05/31/2021] [Indexed: 12/15/2022] Open
Abstract
Background At the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting nonurgent in-person appointments. Even though the VA was an early adopter of telehealth in the late 1990s, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020. Objective We compared telehealth service use at a VA Medical Center, Greater Los Angeles across 3 clinics (primary care [PC], cardiology, and home-based primary care [HBPC]) 12 months before and 12 months after the onset of COVID-19 (March 2020). Methods We used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of monthly outpatient and telehealth visits, as well as telephone and VA Video Connect encounters were examined for each clinic. Semistructured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes. Results Prior to COVID-19, telehealth use was minimal at all 3 clinics, but at the onset of COVID-19, telehealth use increased substantially at all 3 clinics. Telephone was the main modality of patient choice. Compared with PC and cardiology, video-based care had the greatest increase in HBPC. Several important barriers (multiple steps for videoconferencing, creation of new scheduling grids, and limited access to the internet and internet-connected devices) and facilitators (flexibility in using different video-capable platforms, technical support for patients, identification of staff telehealth champions, and development of workflows to help incorporate telehealth into treatment plans) were noted. Conclusions Technological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions to improve access to care beyond the pandemic.
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Affiliation(s)
- Claudia Der-Martirosian
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA, United States.,Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Tamar Wyte-Lake
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA, United States
| | - Michelle Balut
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA, United States
| | - Karen Chu
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA, United States
| | - Leonie Heyworth
- Office of Connected Care/Telehealth Services, Veterans Health Administration, Washington, DC, United States.,Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, United States
| | - Lucinda Leung
- Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Boback Ziaeian
- Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Sarah Tubbesing
- Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Rashmi Mullur
- Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Division of Diabetes, Endocrinology & Metabolism, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA, United States.,Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis, TN, United States
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16
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Der-Martirosian C, Heyworth L, Chu K, Mudoh Y, Dobalian A. Patient Characteristics of VA Telehealth Users During Hurricane Harvey. J Prim Care Community Health 2021; 11:2150132720931715. [PMID: 32507009 PMCID: PMC7278288 DOI: 10.1177/2150132720931715] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction: Research on patient characteristics of telehealth users is relatively new. More studies are needed to understand the characteristics of telehealth users during disasters. This study attempts to bridge this gap and examines patient characteristics of telehealth users compared with nontelehealth users at the Houston VA Medical Center (VAMC) immediately before and after Hurricane Harvey (2017). Methods: Since use of telehealth services reached its peak and gradually declined within 2 weeks after the landfall, the data analyses focused on 14 days before/14 days after Harvey. Two sets of analyses were conducted using chi-square, t test, and one-way analysis of variance: (1) Patient characteristics of telehealth users were compared with nontelehealth users. (2) Patient characteristics were compared between 3 subgroups of telehealth users. Results: Compared with nontelehealth users, telehealth users were older (mean age: 60.8 vs 58.5 years, P < .001) and had a higher mean Nosos health risk score (1.9 vs 1.4, P < .001). They also had a higher mean number of outpatient visits (28.0 vs 19.8, P < .001), higher emergency room use (37% vs 29%, P < .001), and higher rates of hospitalizations (21% vs 13%, P < .001) during the 12 months before Harvey. When compared to less frequent telehealth users, the most frequent telehealth users were the oldest and most medically complex patients. Conclusions: As the largest integrated health care system in the United States, the VA has many advantages favoring successful implementation of telehealth services during disasters. However, more research is needed to better understand how VA telehealth could meet the varying needs of veterans to lower risk of harm during differing types of disasters.
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Affiliation(s)
- Claudia Der-Martirosian
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA
| | | | - Karen Chu
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA
| | - Yvonne Mudoh
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA.,University of Memphis School of Public Health, Memphis, TN, USA
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17
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Ourth HL, Heyworth L, Galpin K, Morreale AP. Virtual care revolution: Impact on clinical pharmacy practices in the Department of Veterans Affairs. J Am Coll Clin Pharm 2021. [DOI: 10.1002/jac5.1475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Heather L. Ourth
- Department of Veterans Affairs Pharmacy Benefits Management Services, Veterans Health Administration Central Office Washington District of Columbia USA
| | - Leonie Heyworth
- Department of Veterans Affairs Office of Connected Care, Veterans Health Administration Central Office Washington District of Columbia USA
- Department of Medicine University of California, San Diego San Diego California USA
| | - Kevin Galpin
- Department of Veterans Affairs Office of Connected Care, Veterans Health Administration Central Office Washington District of Columbia USA
| | - Anthony P. Morreale
- Department of Veterans Affairs Pharmacy Benefits Management Services, Veterans Health Administration Central Office Washington District of Columbia USA
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18
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Jacobs J, Ferguson JM, Van Campen J, Yefimova M, Greene L, Heyworth L, Zulman DM. Organizational and External Factors Associated with Video Telehealth Use in the Veterans Health Administration Before and During the COVID-19 Pandemic. Telemed J E Health 2021; 28:199-211. [PMID: 33887166 DOI: 10.1089/tmj.2020.0530] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To identify organizational and external factors associated with medical center video telehealth uptake (i.e., the proportion of patients using telemedicine) before and early in the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: We conducted a retrospective, observational study using cross-sectional data for all 139 U.S. Veterans Affairs Medical Centers (VAMCs). We used logistic regression analyses to identify factors that predicted whether a VAMC was in the top quartile of VA Video Connect (VVC) telehealth uptake for primary care and mental health care. Results: All 139 VAMCs increased their VVC uptake at least 2-fold early in the pandemic, with most increasing uptake between 5- and 10-fold. Pre-COVID-19, higher VVC uptake in primary care was weakly and positively associated with having more high-risk patients, negatively associated with having more long-distance patients, and positively associated with the prior fiscal year's VVC uptake. During COVID-19, the positive association with high-risk patients and the negative association with long-distance patients strengthened, while weaker broadband coverage was negatively associated with VVC uptake. For mental health care, having more long-distance patients was positively associated with higher VVC uptake pre-COVID-19, but this relationship reversed during COVID-19. Discussion: Despite the marked increase in VVC uptake early in the COVID-19 pandemic, significant VAMC-level variation indicates that VVC adoption was more difficult for some medical centers, particularly those with poorer broadband coverage and less prior VVC experience. Conclusions and Relevance: These findings highlight opportunities for medical centers, VA Central Office, and other federal entities to ensure equitable access to video telehealth.
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Affiliation(s)
- Josephine Jacobs
- Health Economics Resource Center, and Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Divisions of Primary Care and Outcomes Research and Stanford University School of Medicine, Stanford, California, USA
| | - Jacqueline M Ferguson
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Divisions of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - James Van Campen
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Divisions of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Maria Yefimova
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Divisions of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA.,Office of Research Patient Care Services, Stanford Health Care, Stanford, California, USA
| | - Liberty Greene
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Divisions of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Leonie Heyworth
- Office of Connected Care/Telehealth, Department of Veterans Affairs Central Office, Washington, District of Columbia, USA.,Department of Medicine, University of California, San Diego School of Medicine, San Diego, California, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Divisions of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
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19
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Ferguson JM, Jacobs J, Yefimova M, Greene L, Heyworth L, Zulman DM. Virtual care expansion in the Veterans Health Administration during the COVID-19 pandemic: clinical services and patient characteristics associated with utilization. J Am Med Inform Assoc 2021; 28:453-462. [PMID: 33125032 PMCID: PMC7665538 DOI: 10.1093/jamia/ocaa284] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/16/2020] [Accepted: 10/26/2020] [Indexed: 11/14/2022] Open
Abstract
Objectives To describe the shift from in-person to virtual care within Veterans Affairs (VA) during the early phase of the COVID-19 pandemic and to identify at-risk patient populations who require greater resources to overcome access barriers to virtual care. Materials and Methods Outpatient encounters (N = 42 916 349) were categorized by care type (eg, primary, mental health, etc) and delivery method (eg, in-person, video). For 5 400 878 Veterans, we used generalized linear models to identify patient sociodemographic and clinical characteristics associated with: 1) use of virtual (phone or video) care versus no virtual care and 2) use of video care versus no video care between March 11, 2020 and June 6, 2020. Results By June, 58% of VA care was provided virtually compared to only 14% prior. Patients with lower income, higher disability, and more chronic conditions were more likely to receive virtual care during the pandemic. Yet, Veterans aged 45–64 and 65+ were less likely to use video care compared to those aged 18–44 (aRR 0.80 [95% confidence interval (CI) 0.79, 0.82] and 0.50 [95% CI 0.48, 0.52], respectively). Rural and homeless Veterans were 12% and 11% less likely to use video care compared to urban (0.88 [95% CI 0.86, 0.90]) and nonhomeless Veterans (0.89 [95% CI 0.86, 0.92]). Discussion Veterans with high clinical or social need had higher likelihood of virtual service use early in the COVID-19 pandemic; however, older, homeless, and rural Veterans were less likely to have video visits, raising concerns for access barriers. Conclusions and Relevance While virtual care may expand access, access barriers must be addressed to avoid exacerbating disparities.
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Affiliation(s)
- Jacqueline M Ferguson
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Josephine Jacobs
- Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA
| | - Maria Yefimova
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA.,Office of Research Patient Care Services, Stanford Health Care, Stanford, California, USA
| | - Liberty Greene
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Leonie Heyworth
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, Washington, DC, USA.,Department of Medicine, UC San Diego School of Medicine, San Diego, California, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
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20
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Leung LB, Young AS, Heyworth L, Rose D, Stockdale S, Graaff AL, Dresselhaus TR, Rubenstein LV. Do Collaborative Care Managers and Technology Enhance Primary Care Satisfaction with Care from Embedded Mental Health Providers? J Gen Intern Med 2020; 35:3458-3464. [PMID: 32556874 PMCID: PMC7728939 DOI: 10.1007/s11606-020-05660-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/06/2019] [Accepted: 12/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND To improve mental health care access, the Veterans Health Administration (VA) implemented Primary Care-Mental Health Integration (PC-MHI) in clinics nationally. Primary care clinical leader satisfaction can inform model implementation and may be facilitated by collaborative care managers and technology supporting cross-specialty collaboration. OBJECTIVE (1) To determine primary care clinical leaders' overall satisfaction with care from embedded mental health providers for a range of conditions and (2) to examine the association between overall satisfaction and two program features (care managers, technology). DESIGN Cross-sectional organizational survey in one VA region (Southern California, Arizona, and New Mexico), 2018. PARTICIPANTS Sixty-nine physicians or other designated clinical leaders in each VA primary care clinic (94% response rate). MAIN MEASURES We assessed primary care clinical leader satisfaction with embedded mental health care on four groups of conditions: target, non-target mental health, behavioral health, suicide risk management. They additionally responded about the availability of mental health care managers and the sufficiency of information technology (telemental health, e-consult, instant messaging). We examined relationships between satisfaction and the two program features using χ2 tests and multivariable regressions. KEY RESULTS Most primary care clinical leaders were "very satisfied" with care for targeted anxiety (71%) and depression (69%), but not for other common conditions (37% alcohol misuse, 19% pain). Care manager availability was significantly associated with "very satisfied" responses for depression (p = .02) and anxiety care by embedded mental health providers (p = .02). Highly rated sufficiency of communication technology (only 19%) was associated with "very satisfied" responses to suicide risk management (p = .002). CONCLUSIONS Care from embedded mental health providers for depression and anxiety was highly satisfactory, which may guide improvement among less satisfactory conditions (alcohol misuse, pain). Observed associations between overall satisfaction and collaborative care features may inform clinics on how to optimize staffing and technology based on priority conditions.
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Affiliation(s)
- Lucinda B Leung
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Alexander S Young
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.,RAND Corporation, Santa Monica, CA, USA
| | - Leonie Heyworth
- Office of Connected Care/Telehealth, Department of Veterans Affairs Central Office, Washington, DC, USA.,Department of Medicine, UCSD School of Medicine, San Diego, CA, USA
| | - Danielle Rose
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Susan Stockdale
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - A Laurie Graaff
- VISN 22 (VA Desert Pacific Healthcare Network) Primary Care Coordinator, Gilbert, AZ, USA
| | - Timothy R Dresselhaus
- Department of Medicine, UCSD School of Medicine, San Diego, CA, USA.,Primary Care Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Lisa V Rubenstein
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.,RAND Corporation, Santa Monica, CA, USA.,Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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21
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Connolly SL, Stolzmann KL, Heyworth L, Weaver KR, Bauer MS, Miller CJ. Rapid Increase in Telemental Health Within the Department of Veterans Affairs During the COVID-19 Pandemic. Telemed J E Health 2020; 27:454-458. [PMID: 32926664 DOI: 10.1089/tmj.2020.0233] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The use of telemental health via videoconferencing (TMH-V) became critical during the Coronavirus disease 2019 (COVID-19) pandemic due to restriction of non-urgent in-person appointments. The current brief report demonstrates the rapid growth in TMH-V appointments in the weeks following the pandemic declaration within the Department of Veterans Affairs (VA), the largest healthcare system in the United States. Methods: COVID-19 changes in TMH-V appointments were captured during the six weeks following the World Health Organization's pandemic declaration (March 11, 2020-April 22, 2020). Pre-COVID-19 TMH-V encounters were assessed from October 1, 2017 to March 10, 2020. Results: Daily TMH-V encounters rose from 1,739 on March 11 to 11,406 on April 22 (556% growth, 222,349 total encounters). Between March 11-April 22, 114,714 patients were seen via TMH-V, and 77.5% were first-time TMH-V users. 12,342 MH providers completed a TMH-V appointment between March 11-April 22, and 34.7% were first-time TMH-V users. The percentage growth of TMH-V appointments was higher than the rise in telephone appointments (442% growth); in-person appointments dropped by 81% during this time period. Discussion and Conclusions: The speed of VA's growth in TMH-V appointments in the wake of the COVID-19 pandemic was facilitated by its pre-existing telehealth infrastructure, including earlier national efforts to increase the number of providers using TMH-V. Longstanding barriers to TMH-V implementation were lessened in the context of a pandemic, during which non-urgent in-person MH care was drastically reduced. Future work is necessary to understand the extent to which COVID-19 related changes in TMH-V use may permanently impact mental health care provision.
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Affiliation(s)
- Samantha L Connolly
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kelly L Stolzmann
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Leonie Heyworth
- Veterans Health Administration Office of Connected Care/Telehealth, Washington, District of Columbia, USA.,Department of Health Sciences, University of California San Diego, San Diego, California, USA
| | - Kendra R Weaver
- Clinical Operations, Veterans Health Administration Office of Mental Health and Suicide Prevention, Washington, District of Columbia, USA
| | - Mark S Bauer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher J Miller
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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22
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Reddy A, Gunnink E, Deeds SA, Hagan SL, Heyworth L, Mattras TF, Nelson KM. A rapid mobilization of 'virtual' primary care services in response to COVID-19 at Veterans Health Administration. Healthc (Amst) 2020; 8:100464. [PMID: 32992109 PMCID: PMC7434426 DOI: 10.1016/j.hjdsi.2020.100464] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/23/2020] [Accepted: 08/10/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Ashok Reddy
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA; General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA; Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA; Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Eric Gunnink
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Stefanie A Deeds
- General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA; Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Scott L Hagan
- General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA; Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Leonie Heyworth
- Office of Connected Care/Telehealth Services, Veterans Health Administration, USA; Department of Medicine, University of California, San Diego, USA
| | | | - Karin M Nelson
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA; General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA; Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA; Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
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23
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Zulman DM, Wong EP, Slightam C, Gregory A, Jacobs JC, Kimerling R, Blonigen DM, Peters J, Heyworth L. Making connections: nationwide implementation of video telehealth tablets to address access barriers in veterans. JAMIA Open 2019; 2:323-329. [PMID: 32766533 DOI: 10.1093/jamiaopen/ooz024] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/22/2019] [Accepted: 06/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background Video telehealth technology has the potential to enhance access for patients with clinical, social, and geographic barriers to care. We evaluated the implementation of a US Department of Veterans Affairs (VA) initiative to distribute tablets to high-need Veterans with access barriers. Methods In this mixed methods implementation study, we examined tablet adoption (ie, facility-level tablet distribution rates and patient-level tablet utilization rates) and reach (ie, sociodemographic and clinical characteristics of tablet recipients) between 5/1/16 and 9/30/17. Concurrently, we surveyed 68 facility telehealth coordinators to determine the most common implementation barriers and facilitators, and then conducted interviews with telehealth coordinators and regional leadership to identify strategies that facilitated tablet distribution and use. Results 86 VA facilities spanning all 18 geographic regions, distributed tablets to 6 745 patients. Recipients had an average age of 56 years, 53% lived in rural areas, 75% had a diagnosed mental illness, and they had a mean (SD) of 5 (3) chronic conditions. Approximately 4 in 5 tablet recipients used the tablet during the evaluation period. In multivariate logistic regression, tablet recipients were more likely to use their tablets if they were older and had fewer chronic conditions. Implementation barriers included insufficient training, staffing shortages, and provider disinterest (described as barriers by 59%, 55%, and 33% of respondents, respectively). Site readiness assessments, local champions, licensure modifications, and use of mandates and incentives were identified as strategies that may influence widespread implementation of home-based video telehealth. Conclusion VA's initiative to distribute video telehealth tablets to high-need patients appears to have successfully reached individuals with social and clinical access barriers. Implementation strategies that address staffing constraints and provider engagement may enhance the impact of such efforts.
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Affiliation(s)
- Donna M Zulman
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Emily P Wong
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA
| | - Cindie Slightam
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA
| | - Amy Gregory
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA
| | | | - Rachel Kimerling
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA.,VA National Center for Post-Traumatic Stress Disorder, Menlo Park, California, USA
| | - Daniel M Blonigen
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA
| | - John Peters
- Office of Connected Care/Telehealth Services, Veterans Health Administration
| | - Leonie Heyworth
- Office of Connected Care/Telehealth Services, Veterans Health Administration.,Department of Medicine, University of California, San Diego
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24
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Affiliation(s)
- Leonie Heyworth
- Department of Veterans Affairs, San Diego Healthcare System, San Diego, California
- Offices of Telehealth and Primary Care, Department of Veterans Affairs, University of California, San Diego
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25
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Heyworth L, Rozenblum R, Burgess JF, Baker E, Meterko M, Prescott D, Neuwirth Z, Simon SR. Influence of shared medical appointments on patient satisfaction: a retrospective 3-year study. Ann Fam Med 2014; 12:324-30. [PMID: 25024240 PMCID: PMC4096469 DOI: 10.1370/afm.1660] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Shared medical appointments (SMAs) are becoming popular, but little is known about their association with patient experience in primary care. We performed an exploratory analysis examining overall satisfaction and patient-centered care experiences across key domains of the patient-centered medical home among patients attending SMAs vs usual care appointments. METHODS We undertook a cross-sectional study using a mailed questionnaire measuring levels of patient satisfaction and other indicators of patient-centered care among 921 SMA and 921 usual care patients between 2008 and 2010. Propensity scores adjusted for potential case mix differences between the groups. Multivariate logistic regression assessed propensity-matched patients' ratings of care. Generalized estimating equations accounted for physician-level clustering. RESULTS A total of 40% of SMA patients and 31% of usual care patients responded. In adjusted analyses, SMA patients were more likely to rate their overall satisfaction with care as "very good" when compared with usual care counterparts (odds ratio=1.26; 95% CI, 1.05-1.52). In the analysis of patient-centered medical home elements, SMA patients rated their care as more accessible and more sensitive to their needs, whereas usual care patients reported greater satisfaction with physician communication and time spent during their appointment. CONCLUSIONS Overall, SMA patients appear more satisfied with their care relative to patients receiving usual care. SMAs may also improve access to care and deliver care that patients find to be sensitive to their needs. Further research should focus on enhancing patient-clinician communication within an SMA as this model of care becomes more widely adopted.
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Affiliation(s)
- Leonie Heyworth
- Veterans Administration Boston Healthcare System, Jamaica Plain, Massachusetts Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ronen Rozenblum
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - James F Burgess
- Veterans Administration Boston Healthcare System, Jamaica Plain, Massachusetts
| | - Errol Baker
- Veterans Administration Boston Healthcare System, Jamaica Plain, Massachusetts
| | - Mark Meterko
- Veterans Administration Boston Healthcare System, Jamaica Plain, Massachusetts
| | - Debra Prescott
- Harvard Vanguard Medical Associates, Newton, Massachusetts
| | | | - Steven R Simon
- Veterans Administration Boston Healthcare System, Jamaica Plain, Massachusetts Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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26
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Heyworth L, Kleinman K, Oddleifson S, Bernstein L, Frampton J, Lehrer M, Salvato K, Weiss TW, Simon SR, Connelly M. Comparison of interactive voice response, patient mailing, and mailed registry to encourage screening for osteoporosis: a randomized controlled trial. Osteoporos Int 2014; 25:1519-26. [PMID: 24566584 DOI: 10.1007/s00198-014-2629-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Guidelines recommend screening for osteoporosis with bone mineral density (BMD) testing in menopausal women, particularly those with additional risk factors for fracture. Many eligible women remain unscreened. This randomized study demonstrates that a single outreach interactive voice response phone call improves rates of BMD screening among high-risk women age 50-64. INTRODUCTION Osteoporotic fractures are a major cause of disability and mortality. Guidelines recommend screening with BMD for menopausal women, particularly those with additional risk factors for fracture. However, many women remain unscreened. We examined whether telephonic interactive voice response (IVR) or patient mailing could increase rates of BMD testing in high risk, menopausal women. METHODS We studied 4,685 women age 50-64 years within a not-for-profit health plan in the United States. All women had risk factors for developing osteoporosis and no prior BMD testing or treatment for osteoporosis. Patients were randomly allocated to usual care, usual care plus IVR, or usual care plus mailed educational materials. To avoid contamination, patients within a single primary care physician practice were randomized to receive the same intervention. The primary endpoint was BMD testing at 12 months. Secondary outcomes included BMD testing at 6 months and medication use at 12 months. RESULTS Mean age was 57 years. Baseline demographic and clinical characteristics were similar across the three study groups. In adjusted analyses, the incidence of BMD screening was 24.6% in the IVR group compared with 18.6% in the usual care group (P < 0.001). There was no difference between the patient mailing group and the usual care group (P = 0.3). CONCLUSIONS In this large community-based randomized trial of high risk, menopausal women age 50-64, IVR, but not patient mailing, improved rates of BMD screening. IVR remains a viable strategy to incorporate in population screening interventions.
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Affiliation(s)
- L Heyworth
- Brigham and Women's Hospital, Boston, MA, USA,
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27
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Heyworth L, Bitton A, Lipsitz SR, Schilling T, Schiff GD, Bates DW, Simon SR. Patient-centered medical home transformation with payment reform: patient experience outcomes. Am J Manag Care 2014; 20:26-33. [PMID: 24512168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To examine changes in patient experience across key domains of the patient-centered medical home (PCMH) following practice transformation with Lean quality improvement methodology inclusive of payment reform. STUDY DESIGN Pre-intervention/post-intervention analysis of intervention with a comparison group, a quasi-experimental design. We surveyed patients following office visits at the intervention (n = 2502) and control (n = 1622) practices during the 15-month period before and 14-month period after PCMH Lean transformation (April-October 2009). METHODS We measured and compared pre-intervention and post-intervention levels of patient satisfaction and other indicators of patient-centered care. Propensity weights adjusted for potential case-mix differences in intervention and control groups; propensity-adjusted proportions accounted for physician-level clustering. RESULTS More intervention patients were very satisfied with their care after the PCMH Lean intervention (68%) compared with pre-intervention (62%). Among control patients, there was no corresponding increase in satisfaction (63% very satisfied pre-intervention vs 64% very satisfied post-intervention). This comparison resulted in a statistical trend (P = .10) toward greater overall satisfaction attributable to the intervention. Post-intervention, patients in the intervention practice consistently rated indicators of patient-centered care higher than patients in the control practice, particularly in the personal physician and communication domain. In this domain, intervention patients reported superior provider explanations, time spent, provider concern, and follow-up instructions compared with control participants, whereas control group ratings fell in the post-intervention period (P for difference <.05). CONCLUSIONS In a pilot PCMH transformation including Lean enhancement with payment reform, patient experience was sustained or improved across key PCMH domains.
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Affiliation(s)
- Leonie Heyworth
- VA Boston Healthcare System, 150 South Huntington Ave, Bldg 9 (152G), Boston, MA 02130
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Heyworth L, Clark J, Marcello TB, Paquin AM, Stewart M, Archambeault C, Simon SR. Aligning medication reconciliation and secure messaging: qualitative study of primary care providers' perspectives. J Med Internet Res 2013; 15:e264. [PMID: 24297865 PMCID: PMC3868963 DOI: 10.2196/jmir.2793] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/16/2013] [Accepted: 11/04/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Virtual (non-face-to-face) medication reconciliation strategies may reduce adverse drug events (ADEs) among vulnerable ambulatory patients. Understanding provider perspectives on the use of technology for medication reconciliation can inform the design of patient-centered solutions to improve ambulatory medication safety. OBJECTIVE The aim of the study was to describe primary care providers' experiences of ambulatory medication reconciliation and secure messaging (secure email between patients and providers), and to elicit perceptions of a virtual medication reconciliation system using secure messaging (SM). METHODS This was a qualitative study using semi-structured interviews. From January 2012 to May 2012, we conducted structured observations of primary care clinical activities and interviewed 15 primary care providers within a Veterans Affairs Healthcare System in Boston, Massachusetts (USA). We carried out content analysis informed by the grounded theory. RESULTS Of the 15 participating providers, 12 were female and 11 saw 10 or fewer patients in a typical workday. Experiences and perceptions elicited from providers during in-depth interviews were organized into 12 overarching themes: 4 themes for experiences with medication reconciliation, 3 themes for perceptions on how to improve ambulatory medication reconciliation, and 5 themes for experiences with SM. Providers generally recognized medication reconciliation as a valuable component of primary care delivery and all agreed that medication reconciliation following hospital discharge is a key priority. Most providers favored delegating the responsibility for medication reconciliation to another member of the staff, such as a nurse or a pharmacist. The 4 themes related to ambulatory medication reconciliation were (1) the approach to complex patients, (2) the effectiveness of medication reconciliation in preventing ADEs, (3) challenges to completing medication reconciliation, and (4) medication reconciliation during transitions of care. Specifically, providers emphasized the importance of medication reconciliation at the post-hospital visit. Providers indicated that assistance from a caregiver (eg, a family member) for medication reconciliation was helpful for complex or elderly patients and that patients' social or cognitive factors often made medication reconciliation challenging. Regarding providers' use of SM, about half reported using SM frequently, but all felt that it improved their clinical workflow and nearly all providers were enthusiastic about a virtual medication reconciliation system, such as one using SM. All providers thought that such a system could reduce ADEs. CONCLUSIONS Although providers recognize the importance and value of ambulatory medication reconciliation, various factors make it difficult to execute this task effectively, particularly among complex or elderly patients and patients with complicated social circumstances. Many providers favor enlisting the support of pharmacists or nurses to perform medication reconciliation in the outpatient setting. In general, providers are enthusiastic about the prospect of using secure messaging for medication reconciliation, particularly during transitions of care, and believe a system of virtual medication reconciliation could reduce ADEs.
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Affiliation(s)
- Leonie Heyworth
- Veterans Affairs Boston Healthcare System, Section of General Internal Medicine, Boston, MA, United States.
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Heyworth L, Paquin AM, Clark J, Kamenker V, Stewart M, Martin T, Simon SR. Engaging patients in medication reconciliation via a patient portal following hospital discharge. J Am Med Inform Assoc 2013; 21:e157-62. [PMID: 24036155 DOI: 10.1136/amiajnl-2013-001995] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Few ambulatory medication reconciliation tools exist. Transitions between inpatient and outpatient care can result in medication discrepancies. An interdisciplinary team designed a new 'Secure Messaging for Medication Reconciliation Tool' (SMMRT) within a patient web portal and piloted it among 60 patients at a Veterans Affairs hospital, an integrated system with a shared electronic health record. Recently discharged patients used SMMRT to view their medications in a secure email message and replied using SMMRT's interactive form, verifying their medication regimens and clarifying any inaccuracies. In total, 108 medication discrepancies and 23 potential adverse drug events (ADEs) were seen. Nearly 50% of the potential ADEs were classified as serious. Overall, participants were enthusiastic about SMMRT; 90% said they would use SMMRT again. Enabling patients to conduct medication reconciliation through a web portal is feasible in the transition from inpatient to outpatient care and may improve medication safety.
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Affiliation(s)
- Leonie Heyworth
- Section of General Internal Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
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Heyworth L, Zhang F, Jenter CA, Kell R, Volk LA, Tripathi M, Bates DW, Simon SR. Physician satisfaction following electronic health record adoption in three massachusetts communities. Interact J Med Res 2012; 1:e12. [PMID: 23611987 PMCID: PMC3626123 DOI: 10.2196/ijmr.2064] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 09/04/2012] [Accepted: 09/21/2012] [Indexed: 12/01/2022] Open
Abstract
Background Despite mandates and incentives for electronic health record (EHR) adoption, little is known about factors predicting physicians’ satisfaction following EHR implementation. Objective To measure predictors of physician satisfaction following EHR adoption. Methods A total of 163 physicians completed a mailed survey before and after EHR implementation through a statewide pilot project in Massachusetts. Multivariable logistic regression identified predictors of physician satisfaction with their current practice situation in 2009 and generalized estimating equations accounted for clustering. Results The response rate was 77% in 2005 and 68% in 2009. In 2005, prior to EHR adoption, 28% of physicians were very satisfied with their current practice situation compared to 25% in 2009, following EHR adoption (P < .001). In multivariate analysis, physician satisfaction following EHR adoption was correlated with self-reported ease of EHR implementation (adjusted odds ratio [OR] = 5.7, 95% CI 2.1 - 16), resources for practice improvement (adjusted OR = 2.6, 95% CI 1.2 - 6.1), pre-intervention satisfaction (adjusted OR = 4.8, 95% CI 1.5 - 15), and stress (adjusted OR = 5.3, 95% CI 1.1 - 25). Male physicians reported lower satisfaction following EHR adoption (adjusted OR = 0.3, 95% CI 0.2 - 0.6). Conclusions Interventions to expand EHR use should consider additional support for practices with fewer resources for improvement and ensure ease of EHR implementation. EHR adoption may be a factor in alleviating physicians’ stress. Addressing physicians’ satisfaction prior to practice transformation and anticipating greater dissatisfaction among male physicians will be essential to retaining the physician workforce and ensuring the quality of care they deliver.
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Affiliation(s)
- Leonie Heyworth
- VA Boston Healthcare System, Section of General Internal Medicine, Jamaica Plain, MA, United States.
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