Advancing Decisions about Virtual Service Encounters (ADViSE)

Background: Expanded availability of virtual care options in Primary Care provides new opportunities to improve Veterans’ outcomes by aligning encounter modalities with their needs and preferences. Yet, Veterans and their Primary Care physicians (PCPs) currently lack the personalized information about the benefits and

costs of different Primary Care modalities that is needed to maximize the value of Primary Care encounters. Significance: Our proposal is highly relevant to multiple VA operational and research priorities. First, this proposal will directly inform multiple aspects of the VA Fiscal Year 2022 – 2028 Strategic Plan. Second, the

proposed research is closely aligned with key priorities outlined in the VHA Health Information Strategic Plan. Third, our proposed study will directly inform national and local VHA operational efforts to tailor the use of virtual care modalities to optimize Veterans’ healthcare outcomes and experiences. Fourth, our study will make

significant scientific contributions to 4 HSR&D research priority areas: Access to Care, Health Care Value, Primary Care Practice and Complex Chronic Disease Management, and Virtual Care/Telehealth. Innovation & Impact: The Advancing Decisions about Virtual Service Encounters (ADViSE) intervention will

be the first to deliver personalized, interactive information about the potential value of different Primary Care encounter modalities to patients and PCPs. Our team will also be among the first to use the new VA Patient Engagement, Tracking, and Long-term Support (PETALS) platform in patient-oriented research. Additionally,

our research will significantly advance the science of decision-making about healthcare options and thus will have major impact in settings beyond VHA Primary Care. Specific Aims: Aim 1: Assess the perceived benefits and optimal uses of different Primary Care encounter modalities for Veterans with different needs and preferences. Aim 2: Optimize the usability and functionality of

the ADViSE intervention for delivering personalized, interactive information about the value of different Primary Care encounter modalities to Veterans and clinicians. Aim 3: Test the impact of the optimized ADViSE intervention on Veteran-centered outcomes, use of virtual care, and intermediate health outcomes.

Methodology: We will use surveys of Veterans, semi-structured interviews of Veterans, and chart-stimulated recall interviews of VA Ann Arbor Healthcare System (VAAAHS) PCPs to assess perceived benefits and optimal uses of different Primary Care visit modalities. This information will be used to develop Veteran-facing

and PCP-facing messages that will be tailored to Veterans’ modality preferences and target key determinants of informed decision-making about Primary Care encounter modalities. These new messages will be combined with our pilot-tested system for generating and communicating personalized estimates of the copay, travel, and

time costs for different Primary Care encounter modalities. In this novel ADViSE intervention, interactive d ecision support will be delivered to Veterans by text messaging through the PETALS platform and to PCPs by Microsoft Teams and brief coaching. We will then conduct brief iterative user-centered optimization of a

condensed version of the ADViSE intervention. Finally, we will conduct a stepped wedge cluster randomized controlled trial in the VAAAHS to evaluate effects of the fully optimized ADViSE intervention on Veterans’ perceived value of their healthcare (primary outcome); satisfaction with care; copay, travel, and time costs;

preferences for virtual care; use of virtual care; and key electronic quality measures (secondary outcomes). Next Steps/Implementation: We will engage key national and local VA operational stakeholders on our National Advisory Committee (NAC) throughout the study to optimize sustainability and rapidly disseminate

study products and findings. If the ADViSE intervention is found to be effective, we will work closely with our NAC to explore implementation opportunities and pursue an effectiveness-implementation hybrid design trial to evaluate effects and implementation of the ADViSE intervention in other VHA settings.