Accelerating Implementation of Virtual Care in an Integrated Health Care System: Future Research and Operations Priorities

Abstract

BACKGROUND: Virtual care is critical to Veterans Health Administration (VHA) efforts to expand veterans' access to care. Health care policies such as the Veterans Access, Choice, and Accountability (CHOICE) Act and the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act impact how the VHA provides care. Research on ways to refine virtual care delivery models to meet the needs of veterans, clinicians, and VHA stakeholders is needed. OBJECTIVE: Given the importance of virtual approaches for increasing access to high-quality VHA care, in December 2019, we convened a Think Tank, Accelerating Implementation of Virtual Care in VHA Practice, to consider challenges to virtual care research and practice across the VHA, discuss novel approaches to using and evaluating virtual care, assess perspectives on virtual care, and develop priorities to enhance virtual care in the VHA. METHODS: We used a participatory approach to develop potential priorities for virtual care research and activities at the VHA. We refined these priorities through forceranked prioritization and group discussion, and developed solutions for selected priorities. RESULTS: Think Tank attendees (n = 18) consisted of VHA stakeholders, including operations partners (e.g., Office of Rural Health, Office of Nursing Services, Health Services Research and Development), clinicians (e.g., physicians, nurses, psychologists, physician assistants), and health services researchers. We identified an initial list of fifteen potential priorities and narrowed these down to four. The four priorities were (1) scaling evidence-based practices, (2) centralizing virtual care, (3) creating highvalue care within the VHA with virtual care, and (4) identifying appropriate patients for virtual care. CONCLUSION: Our Think Tank took an important step in setting a partnered research agenda to optimize the use of virtual care within the VHA. We brought together research and operations stakeholders and identified possibilities, partnerships, and potential solutions for virtual care.

Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review

“…The successful incorporation of telehealth into health care delivery relies upon the fit between the telehealth modality, care delivery context, and disease management approaches [ 9 , 19 , 50 ]. Presumably, not all areas of health care delivery lend themselves equally well to telehealth, but management of certain chronic diseases (CHF, COPD, and T2DM) may provide good opportunity to replace routine in-person care with telehealth.…”

A Virtual “Think Tank” to Establish Collaborative Leadership Initiative Plans (“CLIPs”)

“…[8][9][10][11] Published literature describes a variety of "Think Tank" formats, widely ranging from highly structured in-person meetings with a small group of local participants (n=18) to a large group of experts distributed all over the globe, virtually participating in an online survey (n=412). 8,10 Brainstorming, reflection, identification of common challenges faced within a professional area, reviews of available resources, and use of online survey tools were all practical components of these "Think Tanks." [8][9][10][11] In order to create a network of interested scholars with a similar focus, the American Association of Colleges of Pharmacy (AACP) Leadership Development Special Interest Group (LD SIG) implemented a virtual think tank (VTT) format during the 2020 AACP Annual Meeting.…”

“…8,10 Brainstorming, reflection, identification of common challenges faced within a professional area, reviews of available resources, and use of online survey tools were all practical components of these "Think Tanks." [8][9][10][11] In order to create a network of interested scholars with a similar focus, the American Association of Colleges of Pharmacy (AACP) Leadership Development Special Interest Group (LD SIG) implemented a virtual think tank (VTT) format during the 2020 AACP Annual Meeting. The VTT enabled participants with similar interests to brainstorm leadership innovation ideas synchronously.…”

How can equitable video visit access be delivered in primary care? A qualitative study among rural primary care teams and patients

“…In the absence of clear evidence, there is an urgent need to identify the right telehealth modality for the right clinical problem for the right patient at the right time. 3 …”

“…In the absence of clear evidence, there is an urgent need to identify the right telehealth modality for the right clinical problem for the right patient at the right time. 3 Finding the optimal role for virtual primary care is particularly critical for historically marginalised and under-resourced populations. While telephone-delivered care may increase access to care, 4 early findings show that when compared with phone-based care, systemically disadvantaged populations (eg, older adults, those in rural or low bandwidth areas, racial and ethnic minorities, unhoused individuals) are less likely to engage in video visits.…”