Understanding and Improving Video-Based Primary Care Delivery to Veterans

背景：[随着COVID-19大流行的爆发，VA初级保健（PC）经历了大量的 在全国范围内，基于视频的接触有所增加。然而，在PC诊所中快速采用基于视频的护理， 因地点而异。鉴于VA致力于继续扩大VA视频连接（VVC），这是主要的 视频会议平台在VA，需要更多的研究，以全面研究为什么以及如何VVC 已在某些研究中心成功采用，并了解VVC扩展在其他研究中心受限的原因。] 意义/影响：[视频护理的障碍和促进因素是多方面的。本研究将 在高VVC和低VVC站点检查PC中VVC使用的患者、提供者和站点级别特征，并识别 以患者为中心、提供者推荐和领导支持的VVC指南， PC诊所这项研究将有助于我们更普遍地了解需要实现什么 接受视频技术。这样的知识将有助于VA，以及医疗保健的提供， 将军深入了解VVC使用的挑战和成功将为未来的改进提供信息， VVC政策、流程和程序适用于所有退伍军人和所有VA设施。] 创新：这项研究将探讨退伍军人的观点，如何在PC中的VVC可以改善，以更好地 满足他们使用视频护理时的需求。这是一个未充分研究的话题。此外，通过了解 供应商和领导层对如何更有效地实施VVC的看法，我们将更好地 了解VA视频护理的全部内容。[This 18个月的试点研究将创建特定于上下文的VVC剧本 对于高和低VVC，使用以患者为中心、提供者推荐和领导的研究中心 supported.这将有助于改善VA基于视频的初级保健和患者结局的交付。 具体目标：这项试点研究的总体目标是确定改善所有退伍军人VVC使用的策略。 1)通过检查患者、提供者， 以及自COVID-19爆发以来VVC使用的站点水平变化（2020年3月至2024年3月，又名研究期）。 2)在全国范围内，描述与PC中VVC使用相关的患者、提供者、研究中心特定因素的特征， 学习期间。 3)从患者、提供者和领导层评估在PC中使用VVC的障碍和促进因素 (VISN/VAMC/CBOC），使用PC中的站点（目标1和2中确定），在3个高VVC和3个低VVC下进行透视。 方法：[不采用、放弃、扩大、传播和可持续性（NASSS）框架将 用于拟议研究的所有方面（数据收集、分析、定量和定性综合） 调查结果）。将使用两种连续的混合方法，其中定量分析（目标1和2）将 首先告知定性访谈（目标3，n=60）在3个高和3个低的采样和数据收集 VVC网站与患者，供应商和领导。使用解释性混合方法， 将有助于解释定量研究结果。除了深度访谈，定性研究将 包括所有6个研究中心的视频护理和VVC使用的文件审查完成所有分析后， 定量和定性研究结果将被映射到NASSS框架中，这将有助于告知 开发以患者为中心、提供者推荐、领导支持和特定背景的VVC PC诊所的剧本。行动手册将包括关于如何提高高VVC和低VVC站点的VVC的策略。 与所有研究运营合作伙伴（OCC、OPC、VEO）、研究合作研究者和退伍军人密切合作 参与小组（VEG），将评估剧本的可行性和可用性。] 后续步骤/实施：[为了评估VVC剧本的有效性，未来的研究可以对 在多个VA站点的PC诊所的行动手册。对行动手册进行试点测试将提供机会， 来自不同站点的反馈，关于如何最好地使行动手册适用于全国VA的所有站点。

Background: [With the onset of the COVID-19 pandemic, VA primary care (PC) experienced a substantial increase in video-based encounters, nationwide. This rapid uptake of video-based care in PC clinics, however, varied by site. Given that the VA is committed to continue expanding VA Video Connect (VVC), which is the main videoconferencing platform at the VA, more research is needed to comprehensively examine why and how VVC was successfully adopted at some sites and understand why VVC expansion was limited at other sites.] Significance/Impact: [Barriers and facilitators to video-based care are many and multifaceted. This study will examine patient, provider, and site-level characteristics of VVC use in PC at high and low VVC sites, and identify patient-centered, provider-recommended, and leadership supported VVC guidelines that are context-specific for PC clinics. This study will contribute more generally to our understanding of what is needed to achieve acceptance of video technology. Such knowledge will be helpful for VA, as well as the delivery of healthcare in general. In-depth understanding about challenges and successes of VVC use will inform future improvements of VVC policies, processes, and procedures for all Veterans, across all VA facilities.] Innovation: This study will examine Veterans’ perspectives about how VVC in PC can be improved to better meet their needs when using video-based care. This is an understudied topic. Furthermore, by learning about the providers’ and leadership’s perspectives on how VVC can be implemented more effectively, we will better understand the full context of VA video care. [This 18-month pilot study will create context-specific VVC playbook for high and low VVC using sites that will be patient-centered, provider-recommended, and leadership supported. This will help improve delivery of video-based primary care and patient outcomes at the VA.] Specific Aims: This pilot study’s overall objective is to identify strategies to improve VVC use for all Veterans. 1) Identify PC clinic sites in the top 5% and bottom 5% of VVC use nationally by examining patient, provider, and site-level variations in VVC use since the onset of COVID-19 (March 2020-March 2024, aka study period). 2) Characterize patient-, provider-, site-specific factors associated with VVC use in PC, nationwide, during the study period. 3) Evaluate barriers and facilitators to using VVC in PC from patients, providers, and leadership (VISN/VAMC/CBOC) perspectives at 3 high and 3 low VVC using sites in PC (identified in Aims 1 & 2). Methodology: [The non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework will be used for all aspects of the proposed study (data collection, analyses, synthesis of quantitative and qualitative findings). Two sequential, mixed methods approaches will be used, where quantitative analyses (Aims 1 & 2) will first inform the sampling and data collection for the qualitative interviews (Aim 3, n=60) at 3 high and 3 low VVC sites with patients, providers, and leadership. Using the explanatory mixed methods, the qualitative data will then help explain quantitative findings. In addition to in-depth interviews, the qualitative research will include document reviews on video-based care and VVC use for all 6 study sites After completing all analyses, quantitative and qualitative study findings will be mapped into the NASSS framework, which will help inform the development of patient-centered, provider-recommended, leadership-supported, and context-specific VVC playbook for PC clinics. The playbook will include strategies on how to improve VVC for high and low VVC sites. In close collaboration with all study operation partners (OCC, OPC, VEO), study Co-Investigators, and Veteran Engagement Groups (VEG), the playbook will be assessed for feasibility and usability.] Next Steps/Implementation: [To assess the effectiveness of the VVC playbook, future studies can pilot test the playbook at PC clinics at multiple VA sites. Pilot testing the playbook will provide the opportunity to receive feedback from different sites on how best to make the playbook suitable for all sites at the VA, nationally.]