Background: Last year, over one million Veterans had an estimated 6.3 million encounters with VA Physical Medicine and Rehabilitation (PM&R) VA providers. Healthcare providers in VA have diagnose and treat Veterans with acute and chronic disability, including special populations such as Veterans with stroke, traumatic brain injury, spinal cord injury, amputation, and age-related disability. Veterans with disabilities often encounter barriers to accessing medical care due to their conditions, while at the same time needing services such as physical and occupational therapy. Telerehabiliation allows Veterans to interact with their VA healthcare provider from the comfort of their home, and has been demonstrated to be safe and effective. Objectives: The goal of this planning grant is to develop a proposal that will compare the use of audit and feedback and a patient targeted marketing strategy for increasing use of VA Video Connect for follow-up visits. In the larger proposal, we will also evaluate how factors such as provider type and setting affect the success of the strategies, and collect data to understand patient and provider experiences, examine associated travel costs and wait times, and conduct economic analyses.
Specific Aims /Methodology:
The aims of this planning grant are to work with the national PM&R and PEPReC to: 1) Refine and test the audit and feedback and patient targeted marketing implementation strategies to inform the development of the proposal of the program; 2) Determine the most appropriate research design and methods, including number of sites involved, sample calculations, and design for economic evaluation; 3) Develop data collection tools for the evaluation including provider and patient surveys and interview guides. Significance: The long-term goal of our efforts to increase telerehabiliation through the use of VA Video Connect include increasing access to care for Veterans, decreasing the costs they experience traveling, decrease cancellations and no-shows, and increase their self-efficacy and engagement in the self- management of their chronic conditions. HSR&D Priorities Addressed: The proposed work also addresses two of the top VA priorities: Improve timeliness of services (increase access to care, and telehealth) and to focus resources more efficiently (strengthening foundational services for geriatric care, spinal cord injury, and traumatic brain injury.) Unique Features: Recently, VA Video Connect has been released nationally is now available to Veterans throughout the country. VA Video Connect allows Veterans to conduct a virtual healthcare visit with their provider using a smartphone, tablet, or laptop. By increasing access to telerehabiliation visits, VA Video Connect has the potential to increase the reach of telerehabiliation services, and subsequently increase access to care, decrease costs for travel, and increase efficiency. To maximize the potential benefits of the technology, VA's national PM&R team is developing implementation strategies to increase use of VA Video Connect for follow-up rehabilitation efforts. Little is known about the comparative effectiveness of implementation strategies in this context. Expected Results: At the conclusion of this project, we expect to have data that will allow the national PM&R office to compare the effectiveness of two different implementation strategies. Next Steps/how results will affect other areas: Our team has extensive experience in implementation science, telerehabiliation, and evaluation; this proposal is the next step in our trajectory of work to increase implementation of telehealth and telerehabiliation. and will provide the foundation in future work to more widely test and disseminate implementation strategies to improve access to care and quality of life for Veterans with disabilities.
While rehabilitation services are critical to the function and well-being of Veterans, they often have difficulty accessing VA facilities due to travel distance and challenges related to their disabilities. Recently, VA released an application called VA Video Connect, which allows Veterans to conduct virtual healthcare visits with their providers using their smartphones, tablets, or laptops. To encourage the use of VA Video Connect, VA Physical Medicine & Rehabilitation (PM&R) is developing an implementation strategy using audit and feedback. The goal of this planning proposal is to develop a submission to evaluate PM&R's implementation strategy using randomization. During the planning grant, we will refine and test the audit and feedback strategy as well as a strategy focused on patient-targeted marketing. The long-term goal of this proposal is to increase access to Rehabilitation Services and improve the health and quality of life of Veterans.
