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FORUM - Translating research into quality health care for Veterans

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The Virtual Care CORE and the Future of VA HSR&D's Telehealth Research

Both within and beyond VA, the use of different technologies to deliver healthcare services at a distance has evolved rapidly in recent decades. Telehealth has emerged as an optimal way to address what has been at times a fundamental mismatch between the supply of healthcare providers and their clinical expertise, and the demand among patients for their services. For example, academically-affiliated VA facilities (particularly in urban areas) often had an overabundance of providers across specialties, while Veterans living in rural areas often had limited access to local mental health or specialty care. In response, some VA medical centers created telehealth “hubs.” Several years ago, the VA New York Harbor Healthcare System established a telemental health hub to provide virtual mental healthcare to rural parts of Texas, Oklahoma, and Pennsylvania. This allowed efficient use of a stable pool of mental healthcare providers at a time when New York facilities experienced a decrease in Veterans walking through their doors due to demographic and geographic changes. Such lessons learned and corresponding practice changes have been a defining story in recent years across healthcare organizations.

As Drs. Evans and Galpin described in their FORUM contribution, the COVID-19 pandemic has served as a powerful catalyst for change in how technologies like synchronous and asynchronous telehealth and remote patient monitoring are used to deliver services. Prior to the pandemic, researchers predicted that by 2025 providers would offer as much as 25 percent of primary care and other visits on a virtual basis. COVID-19 accelerated that time frame by five years. While some preferences for service delivery are drifting back towards pre-pandemic patterns, telehealth and the broader realm of virtual care are now fundamental aspects of the healthcare experience. The task at hand for all healthcare systems, including VA, is to find the right balance of care provided in virtual and traditional, brick-and-mortar settings that matches the needs and preferences of individual Veterans.

In addition to telehealth services, VA offers a broad range of other virtual care technologies to support Veteran healthcare engagement. VA must now determine how to support sustained use of technologies such as VA’s patient portal; to identify and test effective strategies that promote wider uptake of technologies like VA’s automated texting system and suite of mobile health applications; and to think creatively about how these various modalities can be used together to enhance the overall care experience. Doing so will bring us closer to ensuring that virtual care lives up to its potential to improve both access and quality for patients while decreasing disparities.

The Virtual Care Consortium of Research (CORE) was launched in June 2020 to support and foster collaboration among VA HSR&D investigators conducting research with a virtual care focus. Supported by HSR&D, the CORE’s goals are to:

  • Facilitate increased adoption and use of virtual care in VA,
  • Foster research on the impact of virtual care in VA, and
  • Create a robust network of virtual care investigators aligned with the needs and priorities of VA’s Office of Connected Care (OCC).

Highlights of the Virtual Care CORE’s first year include the following.

  1. The Virtual Care CORE Network – In its first year, over 200 researchers, clinicians, and operational partners joined the Virtual Care CORE The CORE offers an email listserv, monthly newsletters, and quarterly Cyberseminars to share information with the network.
  2. Funding for Pilot Projects – Working together with OCC, the Virtual Care CORE circulated two general and one targeted Request for Applications for pilot From the 91 applications received, 18 projects were funded for a total of $2.6 million. This included six projects focused on topics related to virtual care and COVID- 19, 11 projects focused more generally on virtual care, and one field-based evaluation of an anesthesia virtual care program. In addition, we provided support for six early career Virtual Care CORE Associate Investigators to pursue projects that would support their virtual care research and career goals.
  3. Workgroup Development – We have created the first two of what we envision to be a series of workgroups that will address issues important to virtual care researchers in the The Data Sources Working Group includes investigators from some of the OCC-funded pilot projects, united by a common need to understand existing structures related to OCC and other virtual care data. Comprised of experts in telemental health, the Mental Health Working Group has an initial goal of identifying a CORE set of measures that can be used more uniformly by the telemental health field. Our hope is that these and additional workgroups will identify common goals and work together to achieve them, thereby facilitating collaboration in the future.
  4. Virtual Care Portfolio Review – To complement existing systematic reviews of the published literature, we are conducting a systematic portfolio review, identifying all VA virtual care studies and projects within the last 10 This includes work funded by HSR&D, QUERI, and operational offices.
  5. State of the Art (SOTA) Conference – We have begun planning for a 2022 SOTA aimed at identifying gaps in the literature and helping to target future research. We anticipate three focus areas for this SOTA: 1) strategies to help VA bridge the "Digital Divide" and address disparities in access to virtual care; 2) strategies to increase Veteran adoption of and engagement with VA virtual care technologies; and 3) efforts to identify the most promising opportunities to improve quality and outcomes through virtual care.
  6. Setting Research Priorities – Combining the portfolio review with existing systematic reviews will help identify gaps in the virtual care literature and high priority questions that merit investigation in future studies and projects. The SOTA will convene virtual care researchers and operations partners to prioritize those gaps and questions in order to offer guidance for HSR&D’s future research agenda and to inform VA policy and clinical operations.

In the coming year, the Virtual Care CORE will focus on strengthening the network, supporting virtual care research and QI projects, and undertaking the portfolio review and SOTA activities that will guide future research, policy, and clinical operations in VA. We welcome new network members! To learn more about the Virtual Care CORE, check out our website or contact us at VHAVirtualCareCORE@va.gov.

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