Delivery of Health Care, Health Care Costs
Conditions
Keywords
Access, Behavior (patient), Behavior (provider), Rural Health, Patient preferences, Decision support, Telemedicine, Patient-centered Care, Communication (doctor-patient), Cost, Patient outcomes, Primary care, Satisfaction (patient), Virtual care
Brief summary
Expanded availability of virtual care encounters in Primary Care provides new opportunities to improve Veterans' outcomes by aligning encounter modalities with their needs and preferences. Yet, Veterans and their Primary Care physicians (PCPs) lack personalized information about the benefits and costs of different Primary Care modalities that is needed to maximize the value of Primary Care encounters. To address this problem, in this study the investigators will use surveys and interviews to identify what Veterans and PCPs perceive to be the benefits and optimal uses of different Primary Care encounter modalities. They will then supplement their existing system for communicating encounter costs to Veterans and PCPs with new interactive messaging about benefits and optimal uses of different encounter modalities. Finally, this novel Advancing Decisions about Virtual Service Encounters (ADViSE) intervention will be optimized through user-centered refinement before evaluating its effects on Veteran-centered outcomes, use of virtual care, and intermediate health outcomes in a randomized controlled trial (RCT).
Detailed description
The investigators will evaluate, in a stepped wedge cluster RCT, the effectiveness of the optimized ADViSE intervention, which will use interactive text messages for Veterans and point-of-care (POC) information and brief coaching for PCPs to help Veterans and their clinicians make well-informed decisions about available encounter types to meet each Veteran's needs and optimize the perceived value of their healthcare. A mixed methods stepped wedge cluster RCT will be conducted in which the optimized ADViSE intervention will be rolled out to PCPs and Veterans in each of 6 VA Ann Arbor Healthcare System (VAAAHS) Patient Aligned Care Teams (PACTs) in a randomly assigned order. For each Veteran participant, pre-post differences in outcomes during the 6-month intervention period will be compared to a 6-month pre-intervention control period.
Interventions
BEHAVIORALClinician Coaching Sessions
PCPs will receive interactive coaching sessions from a Clinician Coach 2 months into the intervention period and again at 4 months into the intervention period.
OTHERPersonalized text messages to patients
Drawing upon a library of messages that have previously been developed and refined, Veterans will receive 6 months of optimized text messages. The frequency of text messages will be determined based on feedback from Veterans in earlier phases of the research.
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Stepped wedge cluster randomized controlled trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Veteran inclusion criteria are having an upcoming face-to-face (F2F), telephone, or VA Video Connect (VVC) appointment in the next 8 to 12 weeks * Having at least 3 Primary Care F2F, telephone, or VVC encounters in the previous 12 months * Able to provide informed consent * Willing and able to receive text messages from the VA Patient Engagement, Tracking, and Long-term Support (PETALS) platform
Exclusion criteria
* Veteran
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Veterans' perceptions of the value of their healthcare | 6 months prior to intervention and 6-months post intervention | Measured by survey at baseline and intervention end |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| VA Video Connect (VVC) encounters with assigned Patient Aligned Care Team (PACT) | 6 months prior to intervention and 6-months post intervention | Measured using Corporate Data Warehouse (CDW) data |
| Face-to-Face (F2F) encounters with assigned Patient Aligned Care Team (PACT) | 6 months prior to intervention and 6-months post intervention | Measured using CDW data |
| Telephone encounters with assigned Patient Aligned Care Team (PACT) | 6 months prior to intervention and 6-months post intervention | Measured using CDW data |
| Veterans' satisfaction with healthcare | 6 months prior to intervention and 6-months post intervention | Measured by survey at baseline and intervention end |
| Veterans' preferences for virtual care | 6 months prior to intervention and 6-months post intervention | Measured by survey at baseline and intervention end |
| Total healthcare-associated costs for Veterans | 6 months prior to intervention and 6 months post intervention | Sum of copay costs, travel costs, and time costs measured using CDW data |
| Hemoglobin A1c level <8% among Veterans with diabetes | 6 months prior to intervention and 6 months post intervention | Electronic quality measure (eQM) measured using CDW data |
| Blood pressure (BP) < 140/90 among Veterans with diabetes | 6 months prior to intervention and 6 months post intervention | Electronic quality measure (eQM) measured using CDW data |
| Statin use among Veterans with diabetes | 6 months prior to intervention and 6 months post intervention | Electronic quality measure (eQM) measured using CDW data |
| Statin use among Veterans with ischemic heart disease | 6 months prior to intervention and 6 months post intervention | Electronic quality measure (eQM) measured using CDW data |
| Breast cancer screening among female Veterans | 6 months prior to intervention and 6 months post intervention | Electronic quality measure (eQM) measured using CDW data |
| Cervical cancer screening among female Veterans | 6 months prior to intervention and 6 months post intervention | Electronic quality measure (eQM) measured using CDW data |
| Colon cancer screening among Veterans aged 45-75 | 6 months prior to intervention and 6 months post intervention | Electronic quality measure (eQM) measured using CDW data |
| Flu vaccine receipt among Veterans | 6 months prior to intervention and 6 months post intervention | Electronic quality measure (eQM) measured using CDW data |
| Time costs for Veterans | 6 months prior to intervention and 6 months post intervention | Measured using CDW data |
| Travel costs for Veterans | 6 months prior to intervention and 6 months post intervention | Measured using CDW data |
| Copay costs for Veterans | 6 months prior to intervention and 6 months post intervention | Measured using CDW data |
Countries
United States
Contacts
CONTACTJeffrey T Kullgren, MD MPH MS
CONTACTNora A Metzger, BA MSW
PRINCIPAL_INVESTIGATORJeffrey T. Kullgren, MD MPH MS
VA Ann Arbor Healthcare System, Ann Arbor, MI
Outcome results
None listed