Incorporating TechQuity in Virtual Care Within the Veterans Health Administration: Identifying Future Research and Operations Priorities

Conor Walsh, Caitlin Sullivan, Hayden B Bosworth, Sarah Wilson, Jennifer M Gierisch, Kaitlyn B Goodwin, Felicia Mccant, Helen Hoenig, Leonie Heyworth, Donna M Zulman, Carolyn Turvey, Ernest Moy, Allison A Lewinski, Conor Walsh, Caitlin Sullivan, Hayden B Bosworth, Sarah Wilson, Jennifer M Gierisch, Kaitlyn B Goodwin, Felicia Mccant, Helen Hoenig, Leonie Heyworth, Donna M Zulman, Carolyn Turvey, Ernest Moy, Allison A Lewinski

Abstract

Background: The Covid-19 pandemic dramatically changed healthcare delivery, driving rapid expansion of synchronous (i.e., real-time) audio-only and video telehealth, otherwise known as virtual care. Yet evidence describes significant inequities in virtual care utilization, with certain populations more dependent on audio-only virtual care than video-based care. Research is needed to inform virtual care policies and processes to counteract current inequities in access and health outcomes.

Objective: Given the importance of incorporating equity into virtual care within the Veterans Health Administration (VHA), we convened a Think Tank to identify priorities for future research and virtual care operations focused on achieving equitable implementation of virtual care within the VHA.

Methods: We used participatory activities to engage clinicians, researchers, and operational partners from across the VHA to develop priorities for equitable implementation of virtual care. We refined priorities through group discussion and force-ranked prioritization and outlined next steps for selected priorities.

Key results: Think Tank participants included 43 individuals from the VHA who represented diverse geographical regions, offices, and backgrounds. Attendees self-identified their associations primarily as operations (n = 9), research (n = 28), or both (n = 6). We identified an initial list of 63 potential priorities for future research and virtual care operations. Following discussion, we narrowed the list to four priority areas: (1) measure inequities in virtual care, (2) address emerging inequities in virtual care, (3) deploy virtual care equitably to accommodate differently abled veterans, and (4) measure and address potential adverse consequences of expanded virtual care. We discuss related information, data, key partners, and outline potential next steps.

Conclusions: This Think Tank of research and operational partners from across the VHA identified promising opportunities to incorporate equity into the design and implementation of virtual care. Although much work remains, the priorities identified represent important steps toward achieving this vital goal.

Keywords: delivery of healthcare; health equity; health services research; telemedicine; veterans.

Conflict of interest statement

Dr. Bosworth reports receiving research funds from Sanofi, Otsuka, Johnson and Johnson, Improved Patient Outcomes, Novo Nordisk, PhRMA Foundation, as well as consulting funds from Sanofi, Otsuka, Abbott, and Novartis. Dr. Lewinski reports receiving funds from PhRMA Foundation and Otsuka. The remaining authors report no competing interests.

© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

References

    1. Wrigley-Field E, Garcia S, Leider JP, Van Riper D. COVID-19 mortality at the neighborhood level: racial and ethnic inequalities deepened in Minnesota In 2020. Health Aff (Millwood). 2021;40(10):1644-53. 10.1377/hlthaff.2021.00365.
    1. Webb Hooper M, Napoles AM, Perez-Stable EJ. COVID-19 and racial/ethnic disparities. JAMA. 2020;323(24):2466-7. 10.1001/jama.2020.8598.
    1. Lopez L, 3rd, Hart LH, 3rd, Katz MH. Racial and ethnic health disparities related to COVID-19. JAMA. 2021;325(8):719-20. 10.1001/jama.2020.26443.
    1. Patel SY, Mehrotra A, Huskamp HA, Uscher-Pines L, Ganguli I, Barnett ML. Trends in outpatient care delivery and telemedicine during the COVID-19 Pandemic in the US. JAMA Intern Med. 2021;181(3):388-91. 10.1001/jamainternmed.2020.5928.
    1. Schwamm LH, Erskine A, Licurse A. A digital embrace to blunt the curve of COVID19 pandemic. NPJ Digit Med. 2020;3:64. 10.1038/s41746-020-0279-6.
    1. Ferguson JM, Jacobs J, Yefimova M, Greene L, Heyworth L, Zulman DM. Virtual care expansion in the Veterans Health Administration during the COVID-19 pandemic: clinical services and patient characteristics associated with utilization. J Am Med Inform Assoc. 2021;28(3):453-62. 10.1093/jamia/ocaa284.
    1. Eberly LA, Kallan MJ, Julien HM, Haynes N, Khatana SAM, Nathan AS, et al. Patient characteristics associated with telemedicine access for primary and specialty ambulatory care during the COVID-19 pandemic. JAMA Netw Open. 2020;3(12):e2031640. 10.1001/jamanetworkopen.2020.31640.
    1. Karimi M, Lee EC, Couture SJ, Gonzales AB, Grigorescu V, Smith SR, et al. National Trends in Telehealth Use in 2021: Disparities in Utilization and Audio vs. Video Services. (Research Report No. HP-2022-04): Office of the Assistant Secretary for Planning and Evaluation, U. S. Department of Health and Human Services; February 2022.
    1. Nouri S, Khoong EC, Lyles CR, Karliner L. Addressing Equity in Telemedicine for Chronic Disease Management During the Covid-19 Pandemic. NEJM Catalyst. 2020; . Accessed 20 July 2021.
    1. Uscher-Pines L, Sousa J, Jones M, Whaley C, Perrone C, McCullough C, et al. Telehealth use among safety-net organizations in California during the COVID-19 pandemic. JAMA. 2021;325(11):1106-7. 10.1001/jama.2021.0282.
    1. Gray DM, II, Joseph JJ, Olayiwola JN. Strategies for digital care of vulnerable patients in a COVID-19 world—keeping in touch. JAMA Health Forum. 2020;1(6):e200734-e. 10.1001/jamahealthforum.2020.0734.
    1. Lam K, Lu AD, Shi Y, Covinsky KE. Assessing telemedicine unreadiness among older adults in the United States during the COVID-19 pandemic. JAMA Intern Med. 2020;180(10):1389-91. 10.1001/jamainternmed.2020.2671.
    1. Vogels EA. Some digital divides persist between rural, urban and suburban America. Pew Research Center. August 2021. . Accessed 16 April 2022.
    1. Vogels EA. Digital divide persists even as Americans with lower incomes make gains in tech adoption. Pew Research Center. June 2021. .Accessed 16 April 2022.
    1. Rodriguez JA, Shachar C, Bates DW. Digital inclusion as health care - supporting health care equity with digital-infrastructure initiatives. N Engl J Med. 2022;386(12):1101-3. 10.1056/NEJMp2115646.
    1. Lyles CR, Wachter RM, Sarkar U. Focusing on digital health equity. JAMA. 2021;326(18):1795-6. 10.1001/jama.2021.18459.
    1. Sieck CJ, Sheon A, Ancker JS, Castek J, Callahan B, Siefer A. Digital inclusion as a social determinant of health. NPJ Digit Med. 2021;4(1):52. 10.1038/s41746-021-00413-8.
    1. Press VG, Huisingh-Scheetz M, Arora VM. Inequities in technology contribute to disparities in COVID-19 vaccine distribution. JAMA Health Forum. 2021;2(3):e210264-e. 10.1001/jamahealthforum.2021.0264.
    1. Blacklow SO, Lisker S, Ng MY, Sarkar U, Lyles C. Usability, inclusivity, and content evaluation of COVID-19 contact tracing apps in the United States. J Am Med Inform Assoc. 2021;28(9):1982-9. 10.1093/jamia/ocab093.
    1. Rhee K, Dankwa-Mullan I, Brennan V, Clark C. What is TechQuity. J Health Care Poor Underserved. 2021;32(2):xiii-xviii.
    1. US Department of Veterans Affairs. VA reports significant increase in Veteran use of telehealth services. Washington, DC: Office of Public Affairs Media Relations, US Department of Veterans Affairs; November 22, 2019.
    1. US Department of Veterans Affairs. Office of Health Equity. Last Updated January 22, 2020. . Accessed 11 July 2022.
    1. Agha Z, Lofgren RP, VanRuiswyk JV, Layde PM. Are patients at Veterans Affairs medical centers sicker? A comparative analysis of health status and medical resource use. Arch. Intern. Med. 2000;160(21):3252-7. 10.1001/archinte.160.21.3252.
    1. Selim AJ, Berlowitz DR, Fincke G, Cong Z, Rogers W, Haffer SC, et al. The health status of elderly veteran enrollees in the Veterans Health Administration. J. Am. Geriatr. Soc. 2004;52(8):1271-6. 10.1111/j.1532-5415.2004.52355.x.
    1. Vandenberg P, Bergofsky LR, Burris JF. The VA’s Systems of Care and the Veterans Under Care. Generations: Journal of the American Society on Aging. 2010;34(13-19).
    1. US Department of Veterans Affairs Office of Budget Submission. FY 2022 Budget Submission. 2022. . Accessed 19 February 2022.
    1. US Department of Veterans Affairs. VA Video Connect. 2022. . Accessed 19 February 2022.
    1. US Department of Veterans Affairs. Connecting Veterans to Telehealth Care. 2021. . Accessed 19 February 2022.
    1. US Department of Veterans Affairs. VA expands Veteran access to telehealth with iPad services. 2020. . Accessed 19 February 2022.
    1. Lewinski AA, Sullivan C, Allen KD, Crowley MJ, Gierisch JM, Goldstein KM, et al. Accelerating implementation of virtual care in an integrated health care system: future research and operations priorities. J Gen Intern Med 2021;36(8):2434-42. 10.1007/s11606-020-06517-3.
    1. Lentz TA, Curtis LH, Rockhold FW, Martin D, Andersson TLG, Arias C, et al. Designing, conducting, monitoring, and analyzing data from pragmatic randomized clinical trials: proceedings from a multi-stakeholder think tank meeting. Ther Innov Regul Sci. 2020;54(6):1477-88. 10.1007/s43441-020-00175-7
    1. Microsoft Teams. Redmond, WA: Microsoft; 2021.
    1. Peterson A, Charles V, Yeung D, Coyle K. The health equity framework: a science- and justice-based model for public health researchers and practitioners. Health Promot Pract. 2021;22(6):741-6. 10.1177/1524839920950730.
    1. Mahoney JS, Lewin L, Beeber L, Willis DG. Using liberating structures to increase engagement in identifying priorities for the APNA Research Council. J Am Psychiatr Nurses Assoc. 2016;22(6):504-7. 10.1177/1078390316663308.
    1. Gierisch JM, Myers ER, Schmit KM, McCrory DC, Coeytaux RR, Crowley MJ, et al. Prioritization of patient-centered comparative effectiveness research for osteoarthritis. Ann Intern Med. 2014;160(12):836-41. 10.7326/m14-0318.
    1. Chang SM, Carey TS, Kato EU, Guise JM, Sanders GD. Identifying research needs for improving health care. Ann Intern Med. 2012;157(6):439-45. 10.7326/0003-4819-157-6-201209180-00515.
    1. Poll Everywhere. San Francisco, CA; 2021.
    1. Birt L, Scott S, Cavers D, Campbell C, Walter F. Member Checking: A Tool to Enhance Trustworthiness or Merely a Nod to Validation? Qual Health Res. 2016 Nov;26(13):1802-1811. 10.1177/1049732316654870.
    1. Morse JM. Critical analysis of strategies for determining rigor in qualitative inquiry. Qual. Health Res. 2015;25(9):1212-22. 10.1177/1049732315588501.
    1. Centers for Disease Control and Prevention. Severe Hearing Impairment Among Military Veterans. Morbidity and Mortality Weekly Report (MMWR) 2011;60: 955-958.
    1. Hinojosa R, Hinojosa MS. Activity-Limiting Musculoskeletal Conditions in US Veterans Compared to Non-Veterans: Results from the 2013 National Health Interview Survey. PLoS One. 2016 Dec 22;11(12):e0167143. 10.1371/journal.pone.0167143.
    1. Lew HL, Garvert DW, Pogoda TK, Hsu PT, Devine JM, White DK, et al. Auditory and visual impairments in patients with blast-related traumatic brain injury: Effect of dual sensory impairment on Functional Independence Measure. J Rehabil Res Dev. 2009;46(6):819-26. 10.1682/jrrd.2008.09.0129.
    1. Olenick M, Flowers M, Diaz VJ. US veterans and their unique issues: enhancing health care professional awareness. Adv Med Educ Pract. 2015;6:635-9. 10.2147/AMEP.S89479.
    1. Faruque LI, Wiebe N, Ehteshami-Afshar A, Liu Y, Dianati-Maleki N, Hemmelgarn BR, et al. Effect of telemedicine on glycated hemoglobin in diabetes: a systematic review and meta-analysis of randomized trials. CMAJ. 2017;189(9):E341-E64. 10.1503/cmaj.150885.
    1. Lin MH, Yuan WL, Huang TC, Zhang HF, Mai JT, Wang JF. Clinical effectiveness of telemedicine for chronic heart failure: a systematic review and meta-analysis. J Investig Med. 2017;65(5):899-911. 10.1136/jim-2016-000199.
    1. Totten AM, Womack DM, Eden KB, McDonagh MS, Griffin JC, Grusing S, et al. Telehealth: mapping the evidence for patient outcomes from systematic reviews. Rockville (MD) 2016.
    1. Lewinski AA, Walsh C, Rushton S, Soliman D, Carlson SM, Luedke MW, Halpern DJ, Crowley MJ, Shaw RJ, Sharpe JA, Alexopoulos A, Tabriz AA, Dietch JR, Uthappa DM, Hwang S, Ball Ricks KA, Cantrell S, Kosinski AS, Ear B, Gordon AM, Gierisch JM, Williams Jr JW, Goldstein KM. Telehealth for the Longitudinal Management of Chronic Conditions: Systematic ReviewJ Med Internet Res 2022;24(8):e37100. 10.2196/37100.
    1. Hausmann LRM, Cashy J, Moy E. Leveraging VA. Data and Partnerships to Advance Equity-Guided Improvement: Introducing the Primary Care Equity Dashboard. VA Health Services Research & Development Cyber Seminars: Using Data and Information Systems in Partnered Research. February 16, 2021.
    1. Moy E, Hausmann LRM, Clancy CM. From HRO to HERO: Making Health Equity a Core System Capability. Am J Med Qual. 2022 Jan-Feb 01;37(1):81-83. 10.1097/JMQ.0000000000000020.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir