QUERI – Quality Enhancement Research Initiative

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eHealth Partnered Evaluation Initiative

Bedford, MA

Overview:

At present, VA Telehealth Services and VA's Connected Health Office are merging to create a single entity, the Office of Connected Care, which will be responsible for the implementation and evaluation of eHealth technologies across the VA healthcare system. eHealth is a model for the delivery and receipt of healthcare services with an expanding evidence base and great potential to increase access and support the transition from episodic to continuous care. In this model, Veterans, their families, and clinical team members use eHealth technologies that support functions (e.g., communication, behavior support, transactions) that are critical to disease prevention and health management, which, in turn, influence behaviors, processes and outcomes. In an effort to successfully fulfill its mission, the Office of Connected Care is helping fund the eHealth Partnered Evaluation Initiative to support the further implementation of eHealth technologies and to measure their impacts on dimensions of access and other outcomes.

Objectives:

Developed in close consultation with leadership from the Office of Connected Care, the objectives of the eHealth Partnered Evaluation Initiative are to:

  • Implement a patient-level "supported adoption intervention" for secure messaging, and to evaluate the impact of secure messaging use through a one-year randomized trial;

  • Evaluate the initial rollout of VA's automated telehealth text messaging system to Veterans and clinical team members.

    The evaluation activities associated with these objectives will be guided by the Practical, Robust Implementation and Sustainability Model (PRISM).

    Methodology:

    Evaluation activities are being conducted at multiple VA facilities and encompass mixed qualitative and quantitative data collection and analysis techniques. Attributes of particular note include:

    • Development of a patient-level supported adoption intervention for secure messaging comprised of theory-driven reminders, motivational messages, and educational materials across multiple channels (mail, telephone, secure messaging, and face-to-face) to encourage and support use of the technology.
    • An evaluation of the impact of secure messaging as part of a two-group, patient-level randomized trial among Veterans who have opted in, but not used secure messaging.
    • A focus on access as a multi-dimensional construct for measurement as well as Veteran and clinical team member experience, healthcare process measures (e.g., impact on utilization - traditional encounters, telephone, etc.), and improvements in specific processes of care (e.g., information sharing, treatment adjustments, preventive services and appropriate consults).
    • Development of an augmented implementation strategy for VA's automated telehealth text messaging system through case comparison of high and low adoption sites to identify barriers and facilitators to adoption.
    • A pilot randomized evaluation of VA's automated telehealth text messaging system comparing usual implementation to an augmented implementation strategy.

    Operations Partner(s): The eHealth Partnered Evaluation Initiative is working in close collaboration with the Office of Connected Care.

    Principal Investigator: Timothy P. Hogan, PhD, is part of HSR&D's Center for Healthcare Organization and Implementation Research (CHOIR) in Bedford, MA; contact at timothy.hogan@va.gov.