Understanding and Improving Video-Based Primary Care Delivery to Veterans

Background: [With the onset of the COVID-19 pandemic, VA primary care (PC) experienced a substantial increase in video-based encounters, nationwide. This rapid uptake of video-based care in PC clinics, however, varied by site. Given that the VA is committed to continue expanding VA Video Connect (VVC), which is the main

videoconferencing platform at the VA, more research is needed to comprehensively examine why and how VVC was successfully adopted at some sites and understand why VVC expansion was limited at other sites.] Significance/Impact: [Barriers and facilitators to video-based care are many and multifaceted. This study will

examine patient, provider, and site-level characteristics of VVC use in PC at high and low VVC sites, and identify patient-centered, provider-recommended, and leadership supported VVC guidelines that are context-specific for PC clinics. This study will contribute more generally to our understanding of what is needed to achieve

acceptance of video technology. Such knowledge will be helpful for VA, as well as the delivery of healthcare in general. In-depth understanding about challenges and successes of VVC use will inform future improvements of VVC policies, processes, and procedures for all Veterans, across all VA facilities.]

Innovation: This study will examine Veterans’ perspectives about how VVC in PC can be improved to better meet their needs when using video-based care. This is an understudied topic. Furthermore, by learning about the providers’ and leadership’s perspectives on how VVC can be implemented more effectively, we will better

understand the full context of VA video care. [This 18-month pilot study will create context-specific VVC playbook for high and low VVC using sites that will be patient-centered, provider-recommended, and leadership supported. This will help improve delivery of video-based primary care and patient outcomes at the VA.]

Specific Aims: This pilot study’s overall objective is to identify strategies to improve VVC use for all Veterans. 1) Identify PC clinic sites in the top 5% and bottom 5% of VVC use nationally by examining patient, provider, and site-level variations in VVC use since the onset of COVID-19 (March 2020-March 2024, aka study period).

2) Characterize patient-, provider-, site-specific factors associated with VVC use in PC, nationwide, during the study period. 3) Evaluate barriers and facilitators to using VVC in PC from patients, providers, and leadership (VISN/VAMC/CBOC) perspectives at 3 high and 3 low VVC using sites in PC (identified in Aims 1 & 2).

Methodology: [The non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework will be used for all aspects of the proposed study (data collection, analyses, synthesis of quantitative and qualitative findings). Two sequential, mixed methods approaches will be used, where quantitative analyses (Aims 1 & 2) will

first inform the sampling and data collection for the qualitative interviews (Aim 3, n=60) at 3 high and 3 low VVC sites with patients, providers, and leadership. Using the explanatory mixed methods, the qualitative data will then help explain quantitative findings. In addition to in-depth interviews, the qualitative research will

include document reviews on video-based care and VVC use for all 6 study sites After completing all analyses, quantitative and qualitative study findings will be mapped into the NASSS framework, which will help inform the development of patient-centered, provider-recommended, leadership-supported, and context-specific VVC

playbook for PC clinics. The playbook will include strategies on how to improve VVC for high and low VVC sites. In close collaboration with all study operation partners (OCC, OPC, VEO), study Co-Investigators, and Veteran Engagement Groups (VEG), the playbook will be assessed for feasibility and usability.]

Next Steps/Implementation: [To assess the effectiveness of the VVC playbook, future studies can pilot test the playbook at PC clinics at multiple VA sites. Pilot testing the playbook will provide the opportunity to receive feedback from different sites on how best to make the playbook suitable for all sites at the VA, nationally.]