Enhancing Veterans’ Access to Care through Video Telehealth Tablets
Palo Alto, CA
VA Video Connect (VVC) connects Veterans with their healthcare team from anywhere, using encryption to secure a private session. Veterans and their providers jointly decide whether to use VVC for a medical visit. VVC works on nearly any device that has an internet connection and a web camera.
Of the approximate nine million enrolled Veterans receiving VA healthcare, nearly one-third live in rural, highly-rural, and insular island areas, and many others experience transportation and financial challenges that are deterrents to using VA healthcare. These barriers are further compounded for the two million Veterans with mental health conditions, some of whom avoid care due to perceived stigma or privacy concerns. In 2016, VA initiated a program to distribute video-enabled tablets to Veterans with geographic, clinical, or social access barriers to in-person care so that they could receive services in their homes or other convenient locations (Zulman et al., 2019). More than half of tablet recipients live in rural areas and 75% have a mental health diagnosis, providing a unique opportunity to assess the effectiveness of this national dissemination of tablets. (Jacobs et al, 2019).
Objectives of the Enhancing Veterans’ Access to Care through Video Telehealth Tablets QUERI initiative include:
- Examine the reach, adoption, and implementation of tablets to better target high-need patients;
- Evaluate the effectiveness of tablets on Veteran access, clinical outcomes, and experience, and test an enhanced patient assessment tool at randomly-selected facilities; and
- Assess the tablet initiative’s maintenance potential through a budget impact analyses of facility-level costs associated with virtual care expansion.
The Practical Robust Implementation and Sustainability Model (PRISM) evaluates how a particular healthcare program or intervention interacts with the recipients to influence program adoption, implementation, maintenance, reach, and effectiveness (Feldstein A and Glasgow R, 2008).
Guided by the PRISM (Practical Robust Implementation and Sustainability Model) framework, investigators will evaluate VA’s tablet initiative in which the co-primary aims are to determine the effectiveness of tablets and to evaluate implementation. First, investigators will identify opportunities to enhance the reach, adoption, and implementation of the tablet initiative – and will develop an enhanced patient assessment tool to target high-need patients for tablets. Following this, they will evaluate the effectiveness of tablets (comparing tablet recipients with a propensity score matched comparison group). Secondarily, we will assess whether the patient assessment tool (implemented at a random subset of facilities) increases tablet distribution to high-need patients. Finally, they will examine the tablet initiative’s maintenance (i.e., sustainability) potential through a budget impact analysis of facility-level costs associated with implementing and sustaining the tablet program.
This project will examine time-sensitive questions about opportunities to expand access through virtual care, a VA MISSION Act priority. In addition, this project will identify areas in which virtual care may benefit Veterans through changes in utilization of VA services, increased access to care, and potential cost savings to VA and to Veterans (i.e., time and travel).
Corresponding Principal Investigator: Donna Zulman, MD, MS (Donna.Zulman@va.gov ).
Operations Partners: VA’s Office of Rural Health (ORH) and Office of Connected Care.