September 2020

In This Issue: How Research Helps Combat COVID-19
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Use of VA Telehealth Services at VA Los Angeles During the COVID-19 Pandemic

Feature Article

Takeaway: This study will help us understand the implementation practices of telehealth during COVID-19. This will better prepare VA for improving access to virtual care for Veterans during future major public health emergencies.

Although telemedicine has become common, research on the use of telemedicine during major disasters, within and outside of VA, is new. Being able to successfully transition from face-to-face to virtual care during a major crisis, such as the COVID-19 pandemic, can potentially assist with continuity of tele-appropriate outpatient care. Further, to minimize the spread of this novel coronavirus, public health officials throughout the United States are advising all members of the community, including Veterans, to stay home and use social distancing when in public. Given these public health guidelines, there has been a shift within VA to increase use of telemedicine/telehealth for outpatient care visits, as this approach can potentially decrease exposure to COVID-19 and minimize infection. However, it is unknown how telehealth is being implemented at VA during the COVID-19 outbreak.

Research on emergency preparedness for infectious diseases has predominantly focused on hospital emergency room surge capacity, not paying close attention to the critical role primary or specialty care clinics play in providing continuity of care to medically vulnerable patients. This ongoing HSR&D-funded study (May 2020 – March 2021) will examine how telehealth services were, or are being, used at three types of outpatient clinics (primary, specialty, and home-based primary care [HBPC]) within one VA site, since VA telehealth programs vary both by clinic and by site. The VA Greater Los Angeles Healthcare System (VAGLAHS) began implementing mitigation and response efforts to the COVID-19 outbreak in the first week of March. Thus, specific aims of this study are to understand telemedicine capabilities at VHAGLA's primary, cardiology, and HBPC clinics – and how telemedicine capabilities at these three clinics were implemented in response to the COVID-19 crisis.

Methods

To understand the use of telemedicine at each of the three clinics, investigators will be guided by clinical experts and key respondents regarding what was logged into the encounter system during the outbreak. They will use VA data to examine the rate and utilization patterns of tele-visits 12 months before the COVID-19 outbreak (to create a baseline) and will compare those to tele-visit activities at each clinic during and post-COVID-19. Investigators also will identify patient characteristics of telemedicine users.

To evaluate barriers and facilitators to achieving rapid implementation of telemedicine delivery, investigators will conduct individual interviews with 30 key stakeholders and informants, including healthcare providers, hospital administrators, and staff at the three clinics. Investigators will ask respondents about:

• Facility preparedness policies and procedures with regards to telehealth;
• Types of telehealth resources that were made available;
• Types of telehealth services that were used;
• How telehealth services were tracked and coded;
• Types of support received to transition to telemedicine;
• Ability to maintain continuity of care; and
• Facilitators and barriers to implementing the telemedicine response during the outbreak.

Findings

None at this time.

Anticipated Impact

Study findings are expected to provide preliminary data to create a larger, multi-site, multi-clinic study to understand the successes and failures of telehealth during this first wave of COVID-19 and, in turn, to improve quality and access to care for Veterans. This will better prepare VA for future waves, if needed, and other pandemic situations.

Principal Investigator: Claudia Der-Martirosian, PhD, is part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA.

Publications

None at this time.

View study abstract