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Principal Investigator: Danielle Elise Rose
Organization: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
Fiscal Year: 2024
Funding agency: Veterans Affairs
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.]
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