QUERI – Quality Enhancement Research Initiative

Virtual Specialty Care QUERI Program: Implementing and Evaluating Technology Facilitated Clinical Interventions to Improve Access to High Quality Specialty Care for Rural Veterans

Seattle, WA and Iowa City, IA

View program fact sheet

Overview:

To improve access to care for Veterans who live in rural settings, the Office of Rural Health’s (ORH) Veteran Rural Health Resource Centers are developing promising practices that utilize virtual care technologies developed by the Office of Connected Care. The Virtual Specialty Care (VSC) QUERI works with operational partners to determine how emerging technologies can be optimally incorporated into clinical interventions to better serve rural Veterans.

The goal of the VSC QUERI program is to implement and evaluate promising clinical practices incorporating virtual care technologies in order to improve access to high-quality care for Veterans residing in rural settings. To achieve this, VSC QUERI has three specific aims:

• Develop, evaluate, and refine implementation strategies to roll out promising clinical practices that incorporate various virtual care technologies, i.e., telehealth, eHealth, and mHealth (mobile health);
• Evaluate and refine promising clinical practices that incorporate virtual care technologies that are designed to improve access to high-quality care for rural Veterans; and
• Measure implementation costs and assess the budget impact for operational partners.

Findings and Impacts:

Telemedicine Outreach for PTSD. This multi-site project promotes engagement in evidence-based psychotherapies by Veterans with PTSD served in VA’s community based outpatient clinics.  Investigators will identify the most effective and cost-effective implementation strategy for improving rural Veterans’ access to these psychotherapies.

HIE for Dual Use Veterans. This multi-site project promotes Veterans’ adoption of Electronic health information (HIE) exchange for those receiving care in the community. Educational materials generated from this project have been made available to Veterans nationwide through VA’s My HealtheVet website.

Clinical Video Telehealth to Home. This project integrated clinical video telehealth to home (CVT-H) technology into the Home-Based Cardiac Rehabilitation (HBCR) program to improve rural Veterans’ access to cardiac rehab. This project has been used by early adopters at VA medical centers implementing HBCR as part of the Office of Rural Health’s Promising Practices program.

PE Coach Implementation. This project evaluated the effectiveness of a high-intensity implementation strategy to promote adoption of the Prolonged Exposure (PE) therapy mobile app ‘PE Coach’ by therapists and patients. Key lessons from this project were shared with the National Center for PTSD Dissemination and Training Division to inform the development and refinement of the revised PE Coach app. The iOS version of PE Coach 2.0 with an improved provider and patient experience was recently released.

Mobile Cardiac Rehab. This project is piloting the use of the VA FitHeart mobile application, developed in partnership with the VA Office of Connected Care, to assist in the delivery of Home-Based Cardiac Rehabilitation (HBCR) to rural Veterans. This project identified barriers and facilitators to the use of mobile technology for HBCR, determined the usability of VA FitHeart, and developed tools for implementing VA FitHeart into clinical care. The mobile app was revised based on Veteran feedback, which significantly improved perceived usability. The revised mobile application is expected to be released nationally in 2018.

Telemedicine Intensive Care Unit (Tele-ICU). This project is funded by VA’s Office of Rural Health and is designated as one of their Critical Rural Access Solutions. VSC QUERI is evaluating the implementation strategies currently being used to roll out Tele-ICU to intensive care units in small VA medical centers.

Principal Investigators: John Fortney, PhD (John.Fortney@va.gov).

Principal Operational Partners: Office of Rural Health, Office of Connected Care, and Mental Health Services