Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.
School of Nursing, Duke University, Durham, NC, USA.
J Gen Intern Med. 2021 Aug;36(8):2434-2442. doi: 10.1007/s11606-020-06517-3. Epub 2021 Jan 26.
Virtual care is critical to Veterans Health Administration (VHA) efforts to expand veterans' access to care. Health care policies such as the Veterans Access, Choice, and Accountability (CHOICE) Act and the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act impact how the VHA provides care. Research on ways to refine virtual care delivery models to meet the needs of veterans, clinicians, and VHA stakeholders is needed.
Given the importance of virtual approaches for increasing access to high-quality VHA care, in December 2019, we convened a Think Tank, Accelerating Implementation of Virtual Care in VHA Practice, to consider challenges to virtual care research and practice across the VHA, discuss novel approaches to using and evaluating virtual care, assess perspectives on virtual care, and develop priorities to enhance virtual care in the VHA.
We used a participatory approach to develop potential priorities for virtual care research and activities at the VHA. We refined these priorities through force-ranked prioritization and group discussion, and developed solutions for selected priorities.
Think Tank attendees (n = 18) consisted of VHA stakeholders, including operations partners (e.g., Office of Rural Health, Office of Nursing Services, Health Services Research and Development), clinicians (e.g., physicians, nurses, psychologists, physician assistants), and health services researchers. We identified an initial list of fifteen potential priorities and narrowed these down to four. The four priorities were (1) scaling evidence-based practices, (2) centralizing virtual care, (3) creating high-value care within the VHA with virtual care, and (4) identifying appropriate patients for virtual care.
Our Think Tank took an important step in setting a partnered research agenda to optimize the use of virtual care within the VHA. We brought together research and operations stakeholders and identified possibilities, partnerships, and potential solutions for virtual care.
虚拟护理对于退伍军人健康管理局 (VHA) 扩大退伍军人获得护理的机会至关重要。医疗保健政策，如《退伍军人选择和问责法案》(CHOICE 法案) 和《维护内部系统和加强综合外部网络法案》(MISSION 法案)，影响着 VHA 提供护理的方式。需要研究如何完善虚拟护理提供模式，以满足退伍军人、临床医生和 VHA 利益相关者的需求。
鉴于虚拟方法对于增加退伍军人获得高质量 VHA 护理的重要性，2019 年 12 月，我们召集了一个智囊团，即“加速虚拟护理在 VHA 实践中的实施”，以考虑 VHA 内虚拟护理研究和实践的挑战，讨论使用和评估虚拟护理的新方法，评估虚拟护理的观点，并制定优先事项，以加强 VHA 中的虚拟护理。
我们使用参与式方法制定 VHA 虚拟护理研究和活动的潜在优先事项。我们通过强制排名优先化和小组讨论来完善这些优先事项，并为选定的优先事项制定解决方案。
智囊团参与者(n=18)包括 VHA 利益相关者，包括运营合作伙伴(如农村健康办公室、护理服务办公室、卫生服务研究与发展)、临床医生(如医生、护士、心理学家、医师助理)和卫生服务研究人员。我们确定了最初的十五项潜在优先事项清单，并将其缩小到四项。这四项优先事项是(1)扩大循证实践，(2)集中虚拟护理，(3)通过虚拟护理在 VHA 内创造高价值护理，以及(4)确定适合虚拟护理的患者。
我们的智囊团在为 VHA 内优化虚拟护理的使用制定合作研究议程方面迈出了重要一步。我们汇集了研究和运营利益相关者，并确定了虚拟护理的可能性、伙伴关系和潜在解决方案。
