4110 — Incorporating TechQuity in Virtual Care within the Veterans Health Administration: Identifying Future Research and Operations Priorities

Lead/Presenter: Conor Walsh,  COIN - Durham
All Authors: Walsh CW (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC Division of), Sullivan C (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC) Bosworth HB (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, School of Nursing, Duke University, Durham, NC, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC) Wilson S, (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC) Gierisch J (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC) Goodwin KB (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC) McCant F (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC) Hoeing H (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC. Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, Physical Medicine & Rehabilitation Service, Durham Veterans Affairs Medical Center, Durham, NC) Heyworth L (Office of Connected Care/Telehealth, Department of Veterans Affairs Central Office, Washington, District of Columbia, USA., Department of Medicine, University of California, San Diego School of Medicine, San Diego, California, USA.) Zulman DM (Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA) Turvey C (Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA. Office of Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, Iowa, USA.) Moy E (Office of Health Equity, Veterans Health Administration, Washington, DC, USA.) Lewinski AA (Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, School of Nursing, Duke University, Durham, NC)

Objectives:
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 being more dependent on audio-only virtual care than video-based care. Research is needed to inform virtual care policy and processes that will counteract current inequities in access and health outcomes. Given the importance of incorporating equity within virtual care within the Veterans Health Administration (VHA), we convened a Think Tank to identify priorities for future research and virtual care operations focused explicitly on achieving equitable use of virtual care within the VHA.

Methods:
We used participatory activities to engage clinicians, researchers, and operational partners from across 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.

Results:
Think Tank participants included 32 individuals from VHA who represented diverse geographical regions, offices, and backgrounds. Attendees self-identified primarily as operations (n = 8), research (n = 19) or both (n = 5). We identified an initial list of 63 potential priorities for future research and virtual care operations. Following discussion, we narrowed the list to four priorities: (1) measure inequities in virtual care (e.g. utilization and health outcomes with virtual care), (2) address emerging inequities in virtual care (e.g. developing tools and resources to address inequities), (3) deploy virtual care equitably to accommodate differently abled veterans (e.g. eHealth navigators for differently abled), and (4) measure and address potential adverse consequences of expanded virtual care (e.g. potential for delayed diagnoses and impact of new workflows on front-line staff). For each priority, we identified the necessary information, data, and key partners as well as outline potential next steps.

Implications:
Ensuring equitable health care for all veterans, including care delivered virtually, is an urgent priority for VHA. This Think Tank of research and operational partners from across VHA identified promising opportunities to incorporate equity into the design and implementation of virtual care. Equitable virtual care requires developing a thorough understanding and intentional coordination of many domains including virtual care effectiveness, patient digital preferences and readiness, clinical workflows, health information technology, and informatics.

Impacts:
Utilizing virtual care effectively to ensure equitable health outcomes is a complex process. Many factors such as clinical context, incorporation of new technologies and workflows into practice, patient preferences, and digital literacy and capability all play large roles in determining if virtual care best meets patients’ needs. We identified four priority areas that can guide VHA researchers, leaders, and operations partners in developing, implementing, and evaluating if our current virtual care practices promote health equity, and provide ways to improve these areas for the future. Specifically, these priorities can help ensure that virtual care in VHA, as well as all healthcare organizations providing care virtually, promotes health equity so all patients can receive the right care at the right time via the right modality.