Over the past decade, VA has instituted many innovations to try to improve access to specialists, and HSR&D researchers have been involved in helping evaluate them. Strategies include making it easier for patients to access specialty care remotely through synchronous telehealth; e-consults to allow primary care providers to get advice from specialists without requiring an in-person consult; and training up the skills of generalist providers through structured programs of education, case learning, and consultation (the Specialty Care Access Networks-Extension for Community Healthcare Outcomes [SCAN-ECHO], and mini-residencies).

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