Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.
Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
J Gen Intern Med. 2023 Jul;38(9):2130-2138. doi: 10.1007/s11606-023-08029-2. Epub 2023 Jan 17.
The Covid-19 pandemic dramatically changed healthcare delivery, driving rapid expansion of synchronous (i.e., real-time) audio-only and video telehealth, otherwise known as virtual care. Yet evidence describes significant inequities in virtual care utilization, with certain populations more dependent on audio-only virtual care than video-based care. Research is needed to inform virtual care policies and processes to counteract current inequities in access and health outcomes.
Given the importance of incorporating equity into virtual care within the Veterans Health Administration (VHA), we convened a Think Tank to identify priorities for future research and virtual care operations focused on achieving equitable implementation of virtual care within the VHA.
We used participatory activities to engage clinicians, researchers, and operational partners from across the VHA to develop priorities for equitable implementation of virtual care. We refined priorities through group discussion and force-ranked prioritization and outlined next steps for selected priorities.
Think Tank participants included 43 individuals from the VHA who represented diverse geographical regions, offices, and backgrounds. Attendees self-identified their associations primarily as operations (n = 9), research (n = 28), or both (n = 6). We identified an initial list of 63 potential priorities for future research and virtual care operations. Following discussion, we narrowed the list to four priority areas: (1) measure inequities in virtual care, (2) address emerging inequities in virtual care, (3) deploy virtual care equitably to accommodate differently abled veterans, and (4) measure and address potential adverse consequences of expanded virtual care. We discuss related information, data, key partners, and outline potential next steps.
This Think Tank of research and operational partners from across the VHA identified promising opportunities to incorporate equity into the design and implementation of virtual care. Although much work remains, the priorities identified represent important steps toward achieving this vital goal.
Covid-19 大流行极大地改变了医疗保健服务模式，推动了实时音频和视频远程医疗（即虚拟医疗）的快速扩张。然而，有证据表明，虚拟医疗的利用存在显著的不平等现象，某些人群比基于视频的护理更依赖于音频-only 虚拟护理。需要开展研究，为虚拟医疗政策和流程提供信息，以克服当前在获取机会和健康结果方面的不平等。
鉴于将公平性纳入退伍军人健康管理局（VHA）内虚拟医疗的重要性，我们召集了一个思想库，以确定未来研究和虚拟医疗运营的优先事项，重点是在 VHA 内实现虚拟医疗的公平实施。
我们使用参与式活动，让来自 VHA 的临床医生、研究人员和运营伙伴参与进来，制定实现虚拟医疗公平实施的优先事项。我们通过小组讨论和强制排名对优先事项进行了细化，并为选定的优先事项概述了下一步行动。
思想库参与者包括来自 VHA 的 43 人，他们代表了不同的地理区域、办公室和背景。与会者主要将自己的关联自我识别为运营（n = 9）、研究（n = 28）或两者兼而有之（n = 6）。我们确定了未来研究和虚拟医疗运营的 63 项潜在优先事项清单。经过讨论，我们将清单缩小到四个优先领域：（1）衡量虚拟医疗中的不平等现象，（2）解决虚拟医疗中出现的新不平等现象，（3）公平地部署虚拟医疗以适应残疾退伍军人，（4）衡量和解决扩大虚拟医疗的潜在不利后果。我们讨论了相关信息、数据、主要合作伙伴，并概述了潜在的下一步行动。
来自 VHA 的研究和运营伙伴的这个思想库确定了将公平性纳入虚拟医疗设计和实施的有前途的机会。尽管还有很多工作要做，但确定的优先事项代表了实现这一重要目标的重要步骤。
