Understanding and Improving Video-Based Primary Care Delivery to Veterans

背景：[随着新冠肺炎大流行的爆发，退伍军人初级保健(PC)经历了 在全国范围内，基于视频的会面增加。然而，PC诊所对基于视频的护理的快速接受， 因场地不同而不同。鉴于退伍军人事务部致力于继续扩展退伍军人事务部视频连接(VVC)，这是主要的 在退伍军人事务部的视频会议平台上，需要更多的研究来全面检查VVC的原因和方式 在一些站点成功采用了VVC，并理解为什么VVC在其他站点的扩展受到限制。] 意义/影响：[基于视频的护理的障碍和促进者是多方面的。这项研究将 在高VVC和低VVC站点检查PC中VVC使用的患者、提供者和站点级别的特征，并确定 以患者为中心、提供商推荐和领导力支持的VVC指南，具体适用于 个人电脑诊所。这项研究将有助于我们更全面地了解需要实现的目标 对视频技术的接受度。这些知识将有助于退伍军人管理局以及在 将军。深入了解VVC使用的挑战和成功将有助于未来改进 所有退伍军人的VVC政策、流程和程序，适用于所有退伍军人设施。] 创新：这项研究将考察退伍军人如何改进PC中的VVC以获得更好的效果 在使用基于视频的护理时满足他们的需求。这是一个研究不足的话题。此外，通过了解 提供商和领导层对如何更有效地实施VVC的观点，我们将 了解退伍军人事务部视频护理的完整背景。[这项为期18个月的试点研究将创建特定于环境的VVC行动手册 对于高VVC和低VVC，使用将以患者为中心、提供商推荐和领导力的站点 支持。这将有助于改善退伍军人管理局基于视频的初级保健和患者结局的提供。] 具体目标：这项初步研究的总体目标是为所有退伍军人确定改善VVC使用的策略。 1)通过检查患者、提供商、 以及自新冠肺炎启动以来(2020年3月至2024年3月，又名研究期间)VVC使用的站点级变化。 2)确定与VVC在全国范围内的使用有关的患者、提供商、站点的特定因素 学习期间。 3)评估患者、提供商和领导层在PC中使用VVC的障碍和促进者 (VISN/VAMC/CBOC)使用PC站点的3个高VVC和3个低VVC的视角(在目标1和2中确定)。 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)。将使用两种顺序的、混合的方法，其中将使用定量分析(目标1和2) 首先通知定性访谈的抽样和数据收集(目标3，n=60)，分3高3低 VVC站点，包括患者、提供者和领导层。使用解释性混合方法，定性数据 将有助于解释定量的发现。除了深入访谈外，定性研究还将 包括在完成所有分析后对所有6个研究站点的基于视频的护理和VVC使用的文件审查， 定量和定性研究结果将被纳入NASSS框架，这将有助于提供信息 开发以患者为中心、提供商推荐、领导力支持和特定环境的VVC 个人电脑诊所的攻略。这本手册将包括如何提高高VVC和低VVC站点的VVC的策略。 与所有研究操作合作伙伴(OCC、OPC、VEO)、研究联合调查员和资深人士密切合作 将评估该行动手册的可行性和可用性。] 下一步/实施：[要评估VVC行动手册的有效性，未来的研究可以试行测试 在多个退伍军人事务部的个人电脑诊所的攻略。试行测试攻略将提供获得 来自不同站点的反馈，关于如何最好地使该手册适用于退伍军人管理局全国所有站点。]

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.]