Advancing Decisions About Virtual Service Encounters

N/ANot Yet RecruitingNCT06539988

VA Office of Research and Development600 enrolled

Overview

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).

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

Interventions

Clinician Coaching SessionsBEHAVIORAL

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.

Personalized text messages to patientsOTHER

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.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

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 exclusion criteria are a CDW diagnosis of mild cognitive impairment, dementia, or a psychotic disorder

Outcomes

Primary Outcomes

Veterans' perceptions of the value of their healthcare

Measured by survey at baseline and intervention end

Time frame: 6 months prior to intervention and 6-months post intervention

Secondary Outcomes

VA Video Connect (VVC) encounters with assigned Patient Aligned Care Team (PACT)

Measured using Corporate Data Warehouse (CDW) data

Time frame: 6 months prior to intervention and 6-months post intervention

Face-to-Face (F2F) encounters with assigned Patient Aligned Care Team (PACT)

Measured using CDW data

Time frame: 6 months prior to intervention and 6-months post intervention

Telephone encounters with assigned Patient Aligned Care Team (PACT)

Measured using CDW data

Time frame: 6 months prior to intervention and 6-months post intervention

Veterans' satisfaction with healthcare

Measured by survey at baseline and intervention end

Time frame: 6 months prior to intervention and 6-months post intervention

Veterans' preferences for virtual care

Measured by survey at baseline and intervention end

Time frame: 6 months prior to intervention and 6-months post intervention

Total healthcare-associated costs for Veterans

Sum of copay costs, travel costs, and time costs measured using CDW data