Virtual Medical Modality Implementation Strategies for Patient-Aligned Care Teams to Promote Veteran-Centered Care: Protocol for a Mixed-Methods Study

Abstract

BackgroundThe Veterans Health Administration (VHA) is making system-wide efforts to increase integrated use of health information technology (HIT), including My HealtheVet (MHV), the Veterans Affairs (VA) electronic patient portal, Vet Link kiosks, telehealth, and mobile apps. Integrated use of HIT can increase individual and system efficiency, maximize resources, and enhance patient outcomes. Prior research indicates that provider endorsement and reinforcement are key determinants of patient adoption of HIT. HIT implementation strategies need to reflect providers’ perspectives to promote adoption and endorsement of these tools; however, providers often lack awareness or are unmotivated to incorporate HIT into clinical care with their patients. When these modalities are used by patients, the approach is often fragmented rather than integrated within and across care settings. Research is needed to identify effective implementation strategies for increasing patient-aligned care team (PACT) member (ie, the VHA’s Patient Centered Medical Home) awareness and motivation to use HIT in a proactive and integrated approach with patients.ObjectiveThis paper describes the rationale, design, and methods of the PACT protocol to promote proactive integrated use of HIT.MethodsIn Aim 1, focus groups (n=21) were conducted with PACT members (n=65) along with questionnaires and follow-up individual interviews (n=16). In Aim 2, the team collaborated with VA clinicians, electronic health researchers and operational partners to conduct individual expert interviews (n=13), and an environmental scan to collect current and emerging provider-focused implementation tools and resources. Based on Aim 1 findings, a gap analysis was conducted to determine what implementation strategies and content needed to be adapted or developed. Following the adaptation or development of resources, a PACT expert panel was convened to evaluate the resultant content. In Aim 3, a local implementation of PACT-focused strategies to promote integrated use of HIT was evaluated using pre- and postquestionnaire surveys, brief structured interviews, and secondary data analysis with PACT members (n=63).ResultsStudy enrollment for Aim 1 has been completed. Aims 1 and 2 data collection and analysis are underway. Aim 3 activities are scheduled for year 3.ConclusionsThis work highlights the practical, technological, and participatory factors involved in facilitating implementation research designed to engage PACT clinical members in the proactive integrated use of HIT. These efforts are designed to support the integrated and proactive use of VA HIT to support clinical care coordination in ways that are directly aligned with PACT member preferences. This study evaluated integrated VA HIT use employing mixed-methods and multiple data sources. Deliverables included PACT-focused strategies to support integrated use of HIT in the ambulatory care setting that will also inform strategy development in other systems of care and support subsequent implementation efforts at regional ...

Proactive integrated virtual healthcare resource use in primary care

“…This paper reports findings from an Institutional Review Board approved concurrent mixed-method implementation study (J [ 10 ].).…”

“…A complete description of participant selection and recruitment is published (J [ 10 ].). In short, using outgoing Secure Messages as a proxy for VHR use, primary care teams were ranked “high” or “low” utilization.…”

“…Currently there are no established best practices to guide clinical practice [ 9 ]. The aims of this research were to: (1) examine primary care use and perceptions of VHR among high- and low- utilization groups; (2) determine the level of integration of VHR in primary care, and identify best practices; and (3) identify implementation of strategies to promote primary care use and integration of VHR across the health care continuum (J [ 10 ].).…”

Transforming Health and Resiliency Through Integration of Values-based Experiences: Implementation of an Electronic Evidence-based Whole Health Clinical Program

“…Implementation strategies [ 24 ] facilitated the strategic steps used to reach the population (ie, veterans) with an effective program (ie, THRIVE) through a new service delivery (ie, electronic). This rapid practical application of implementation strategies was based on best practices [ 24 ], literature [ 24 ], experience of the implementation team [ 25 , 26 ], and the needs of the program in the real-time implementation. [ Implementation strategies are hereafter presented in parenthesis in the following sections.]…”

Provider reported value and use of virtual resources in extended primary care prior to and during COVID-19

“…The parent study [6] was designed to evaluate implementation strategies to promote VHR use among primary care providers. After consent, data were collected via paper and online surveys through VA Research Electronic Data Capture (REDCap) [7,8].…”