CompreHEnsive ViRtual Care for WOmen VEteranS (HEROES)

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Background: Women’s health care within the VA is at a pivotal juncture. By 2040, the proportion of Veterans who are women is expected to nearly double, from 9% (2018) to 17%. Distinct from men, women Veterans (WV) are more racially and ethnically diverse, younger, and more likely to be single heads of households; all of which have implications for health care engagement. The shift in age portends increasing women-specific preventive and reproductive health care needs and a growing burden of chronic illnesses. Significance: These shifts in the WV population require the VHA to innovate and adapt to continue to meet WV health care needs. Virtual care will be a part of ongoing health care service changes and innovations, and has shown specific potential for WV. However, we do not know how and when to deploy virtual care to optimize patient engagement and clinical outcomes for WV. Addressing key areas of uncertainty in virtual VHA care deployment for women could accelerate strategic utilization and successful implementation of virtual care for WV, thereby improving patient satisfaction, quality of care, and health outcomes. This project addresses the legislative priorities of the Deborah Sampson Act (H.R.2452); HSRD priorities of women's health, Virtual Care, health equity; and ORD priorities of promoting diversity, equity, and inclusion, as well as leveraging VA research for real-world impact. Innovation and Impact: Our proposal has four key areas of scientific innovation, including: 1) advancing comprehensive, women’s care delivery by completing the first synthesis of qualitative literature around women’s experiences with virtual care; 2) addressing key information gaps identified by a recent VHA virtual care multi-stakeholder think tank; 3) advancing the science of qualitative evidence synthesis through innovative incorporation of stakeholder input; and 4) bridging a methodologic gap for translating implementation strategies into real-world actions. Specific Aims: 1) To identify barriers and facilitators to the adoption and sustainability of appropriate virtual care delivered within comprehensive WHCs; 2) To develop an implementation blueprint for how and when to optimize adoption and sustainability of appropriate virtual care in the context of VA comprehensive women’s health care; and 3) To explore the impact of the novel implementation blueprint on use of appropriate virtual care in comprehensive WHCs using a mixed methods field test design. Methodology: For Aim 1, we will review the qualitative peer-reviewed literature on women’s experiences with virtual care, as well as collect primary qualitative data from marginalized women Veteran populations (eg., Black WV, rural women) and their care providers to fill gaps in existing literature and explore the specific VA context of synchronous virtual care for WV. For Aim 2, we will map barriers and facilitators to relevant strategies and outcomes for implementation, and engage key multi-level stakeholders to define actionable applications of identified strategies within comprehensive WHCs. For Aim 3, we will work with the VA Women’s Health Practice Based Research Network and the Office of Rural Health to identify two comprehensive women’s health clinics with which to conduct an evaluation of the implementation blueprint. primary qualitative interviews and clinical providers of WV health care. Implementation: The product of this work will be a blueprint for when and how to incorporate synchronous virtual care into comprehensive care for WV. We will maintain close communication with our operations partners from the Office of Connected Care, Office of Rural Health, and Women’s Health Services throughout the proposed work and plan iteratively with them for dissemination. Ultimately, this proposed work has the potential to improve effectiveness of, and satisfaction with, comprehensive care for WV within the VA by delivering health care at the right time with the right modality for the clinical situation and patient's needs.