Research and Methods Core - Telehealth Research and Innovation for Veterans with Cancer (THRIVE)

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The Veterans Affairs Health Administration (VA) is the largest integrated health care system in the US, caring for nearly 50,000 veterans with newly diagnosed cancer annually. Equitable, quality care for all veterans is a tenet of the VA healthcare mission. We hypothesize that three particular factors – race, poverty and rurality – are critical in determining access to healthcare, especially telehealth; we refer to these 3 factors as the social determinants of telehealth (SDTH). Approximately 25% of veterans live in rural areas where there may not be adequate local VA cancer care facilities. Unfortunately, these same communities often lack specialized community-based cancer care services as well, making telehealth a necessary option to reduce geographic, economic and racial barriers to quality, timely cancer care. However, little is known about how telehealth delivery for veterans with cancer impacts equitable delivery of quality care, clinical outcomes and experiences of care. As a national integrated health care system focused on quality and equity of cancer care, VA provides an outstanding national laboratory to examine how use of telehealth affects access, quality and equity of care. We will be able to examine how interventions targeting SDTH affect the use of telehealth and how use of telehealth affects quality and equity. We will disseminate this information broadly to help other health care systems understand how best to integrate telehealth into the continuum of cancer care. Using principles of implementation science, Telehealth Research and Innovation for Veterans with Cancer (THRIVE) will leverage Health Disparities Research Framework (HDRF) to advance the science of health equity: building a new model of cancer care delivery addressing SDTH and fulfilling the promise of access to excellent cancer care for veterans regardless of communication format. The Research and Methods Core primarily focuses on health equity, particularly understanding how SDTH impact access to and quality of care. Our multidisciplinary team will achieve THRIVE’s vision by focusing on lung, colorectal, prostate and breast cancers and accomplishing five specific aims: (1) Assess stakeholders’ perspectives of contextual factors impacting cancer telehealth implementation and sustainment at multiple levels; (2) Measure the use of in- person and telehealth communication formats for cancer care throughout VA; (3) Evaluate how the use of telehealth for cancer care, controlling for social determinants of telehealth – specifically race/ethnicity, poverty, and rurality – are associated with cancer care quality; (4) Oversee the selection, development, implementation and evaluation of 10 rapid-cycle pilot studies (2/year) at the intersection of health equity, implementation science and telehealth cancer care; and (5) Frame the affordability of scaling up effective interventions that are identified from the pilot studies.