This study aims to conduct a pilot of an intervention to improve care coordination between VA and non-VA providers using the Blue Button feature of the Department of Veterans Affairs'(VA) personal health record, My HealtheVet (MHV). Background: The Blue Button feature of My HealtheVet allows veterans to print out a comprehensive summary of their health that can be shared with non-VA providers. It includes a complete medication list with up-to-date information drawn from CPRS. It also includes information about a veteran's most recent laboratory results and wellness reminders. Dual use is common and has been associated with negative health outcomes including higher mortality. However, preliminary data collected by the principal investigator in collaboration with the My HealtheVet Performance Evaluation workgroup shows that few veterans enrolled in My HealtheVet use it to inform either VA or non- VA providers of their care. To remedy this, the principal investigator has developed an online video and companion paper-based training. This training will teach veterans how to use the Blue Button feature of My HealtheVet and why it is important to share the print out with their non-VA provider. Methods: To participate, veterans must have a non-VA provider with a visit within 3 months of enrollment. Only veterans who have never used the Blue Button feature are eligible. Fifty veterans will be randomized to receive either training on how to use the Blue Button or training on how to evaluate the validity of health information found on the Internet. Veterans in both arms will receive training materials, a follow-up phone visit to address any questions or difficulties that arose when using the materials, and a phone reminder one week before the non-VA provider visit. At the non-VA provider visit, both the veteran and the provider will be asked to indicate what occurred during the visit, including whether or not the veteran gave the provider the Blue Button print out. Both veterans and providers will also be asked to complete a brief 15-minute qualitative interview about their experience during the visit. Medical records of the non-VA provider visit will also be obtained. Outcomes: The main outcome for the study is whether the patient provided the non-VA provider a copy of his or her Blue Button print out. It is hypothesized that this will occur more frequently in the visits for veterans who received specific Blue Button training. In addition, comparison between the VA and non-VA provider records will be conducted to test whether veterans who completed the training had 1) better medication reconciliation between the VA and the non-VA provider and 2) fewer instances of therapeutic or laboratory duplication. Pilot funding is needed to 1) determine the effect size of the training intervention on both primary and secondary outcomes;2) establish the feasibility of assessments collected about what occurred during the non-VA provider visit;and 3) validate the metrics of therapeutic and laboratory duplication. Qualitative analysis of the post- visit intervies will be conducted to identify key themes about how the Blue Button print out may influence care coordination. Veteran characteristics such as age, race, gender, computer literacy, and patient activation will also be explored in relation to study participation and the primary outcomes of the study. The results of this pilot will be used to inform a larger randomized controlled trial of the training intervention. Eventual dissemination will be low cost as the training materials can be distributed easily online.

Public Health Relevance

This study aims to conduct a pilot of an intervention to improve care coordination between VA and non-VA providers using the Blue Button feature of the Department of Veteran's Affairs'(VA) personal health record, My HealtheVet (MHV). The Blue Button feature of My HealtheVet allows veterans to print out a comprehensive summary of their health that can be shared with non-VA providers. However, preliminary data collected by the principal investigator indicates that MHV is not often used for care coordination. This study will test an easy-to-use training to help veterans improve their care coordination using the Blue Button feature. We predict that veterans who receive this training will have fewer medication errors and duplication of services between the VA and outside providers. Pilot support is needed to test the feasibility of these methods and to inform a larger randomized controlled trial of this training.

Agency
National Institute of Health (NIH)
Institute
Veterans Affairs (VA)
Type
Veterans Administration (I21)
Project #
1I21HX001390-01
Application #
8596261
Study Section
HSR-3 Informatics and Research Methods Development (HSR3)
Project Start
2013-11-01
Project End
2014-10-31
Budget Start
2013-11-01
Budget End
2014-10-31
Support Year
1
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Iowa City VA Medical Center
Department
Type
DUNS #
028084333
City
Iowa City
State
IA
Country
United States
Zip Code
52245