EXTEND: EXpanding expertise Through E-health Network Development

Rlr Va Medical Center, Indianapolis IN

Investigators

Linked publications & trials

Abstract

Background and Specific Aims: The signature focus of the proposed EXTEND QUERI will be to support and advance a key tenet of VA modernization: ?providing high-quality care to Veterans, Anywhere to Anywhere.? Working in the VA service lines of Primary and Specialty Care, the EXTEND QUERI?s specific aims are to: Aim 1. Expand the reach and effectiveness of VA care to improve Veteran outcomes by delivering high-quality evidence-based telehealth care services ?Anywhere to Anywhere?; Aim 2. Identify and apply successful strategies for optimizing shared care between telehealth, specialty, and primary care services for Veterans served by telehealth services; Aim 3. Identify factors that influence adaptation, adoption, and sustainment of VA telehealth services; and Aim 4. Assess the business case for implementing, scaling, and sustaining telehealth care services. Methods: With the ongoing input of our key partners, these aims will be accomplished via core quality improvement projects that cover multiple conditions and care settings. Our projects focus on: 1) TeleNeurology: We propose an EXTEND TeleNeurology clustered randomized trial of standard video TeleNeurology consultation compared to a ?TeleNeurology to Local? (T2L) teleconsultation program where local providers are trained to provide initial consultation for Veterans post-acute stroke/transient ischemic attack (TIA) with specialty e-consultation backup. 2).TelePain: We will focus on implementation of collaborative care for chronic pain in primary care. National scale-up of this program will focus on embedding the practice within newly established primary care VISN telehealth clinical resource hubs. 3).TeleGRACE: We will extend the reach of an existing multidisciplinary care program that delivers home-based geriatric care management to older Veterans by making it available to a new group of Veterans: those who (a) live at a distance from a VA facility and (b) have an inpatient stay at a VA or non-VA facility. The Geriatric Resources for Assessment and Care of Elders (GRACE) program involves geriatricians, social workers, nurses, and primary care providers working together to care for aging Veterans in their own homes. These projects are supported by an Implementation and Data Core that works across all projects to facilitate efficient models of telehealth delivery and shared care; usability testing of new reports, tools, and products; and standardized use of implementation measures, methods, and analytic approaches. Our overarching implementation bundle of four key implementation strategies includes: Systems Redesign methodology; external facilitation; precision monitoring with feedback; and local adaptation. We will use the RE-AIM and CFIR framework to plan data collection and analyses across projects to identify core implementation strategies and contextual factors that impact effective telehealth delivery. Anticipated EXTEND program impacts include: (1) expanding Veteran access to evidence-based care via telehealth services, (2) identifying and applying effective models of telehealth that directly improve the quality of VA care, and (3) maintaining evidence-based telehealth practices over time in VA care settings through effective sustainment strategies. Each project has been strategically designed to leverage the unique organizational strengths of the VA -- spanning local, VISN, and national levels -- when developing these new, emerging models of telehealth that complement traditional VA care. In the VA Plan for Modernization, the EXTEND QUERI Center addresses the central VA priority (?Lane of Effort?) of Improving Access to Care (Mission Act). We also will address optimizing shared care between specialty and primary care providers, healthcare teams, and Veterans to improve healthcare delivery and outcomes. In total, this program will define and refine models and strategies for VHA to use to deliver effective healthcare as it leads the nation in telehealth delivery ?Anywhere to Anywhere.?