Controlled Trial of Tele-Support and Education for Womens Health Care in CBOCs
| Status: | Completed |
|---|---|
| Conditions: | Contraception, Contraception, Overactive Bladder, Urology |
| Therapuetic Areas: | Gastroenterology, Nephrology / Urology, Reproductive |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 10/25/2018 |
| Start Date: | March 1, 2013 |
| End Date: | September 30, 2018 |
VA community-based outpatient clinics (CBOCs) typically serve only a small number of women
Veterans, and generally do not have the women's health care resources that are available in
larger settings. Women Veterans using these sites for primary care must sometimes travel to
other sites to receive women's health care. That can create travel burdens, reduce continuity
of care, and negatively affect patient outcomes. To address this, VA is implementing a
clinical operations innovation that supports women's primary care providers with a
technology-based intervention that combines interactive communication with women's health
specialists and ongoing education. This research study is evaluating the implementation and
effects of this women's healthcare delivery innovation. Findings from this research will
inform VA women's health clinical practice and education, and will advance science in
delivering technology-supported non-face-to-face care that is applicable to other clinical
conditions and patient populations.
Veterans, and generally do not have the women's health care resources that are available in
larger settings. Women Veterans using these sites for primary care must sometimes travel to
other sites to receive women's health care. That can create travel burdens, reduce continuity
of care, and negatively affect patient outcomes. To address this, VA is implementing a
clinical operations innovation that supports women's primary care providers with a
technology-based intervention that combines interactive communication with women's health
specialists and ongoing education. This research study is evaluating the implementation and
effects of this women's healthcare delivery innovation. Findings from this research will
inform VA women's health clinical practice and education, and will advance science in
delivering technology-supported non-face-to-face care that is applicable to other clinical
conditions and patient populations.
Project Background/Rationale: Women Veterans are a rapidly growing proportion of VA patients.
While entitled to receive care equivalent to their male counterparts, women Veterans may
receive lower quality care, in part due to a VA primary care (PC) workforce that has limited
experience caring for women, particularly their gender-specific conditions. This workforce
may be especially challenged in community-based outpatient clinics (CBOCs), where access to
women's health (WH) expertise may not be readily available. CBOC PC providers (PCPs)
typically have small caseloads of women Veterans, making it difficult for these providers to
maintain their WH knowledge and skills. To ensure quality care for women Veterans, VA
mandated designated WH providers (DWHPs) in every VA facility, and instituted intensive
training opportunities-"WH mini-residencies"-for these providers. Although highly valuable in
delivering a standard level of specialized WH training, these one-time trainings are not
sufficient, as knowledge attenuates over time. Serial education re-enforcement over time is
needed to produce and maintain long-term gains in knowledge. Furthermore, additional
supports, such as enhanced communication between PCPs and specialists, are necessary to
achieve and sustain quality gains. To address these issues, VA is implementing a clinical
operations innovation that is designed to improve CBOC-based DWHP delivery of comprehensive
WH care. This innovation (entitled DWHP Support) combines: 1) advanced WH serial
patient-based education that exposes DWHPs, over time, to a depth and breadth of WH cases and
issues (SCAN-ECHO); and 2) interactive communication between CBOC DWHPs and VA Medical
Center-based specialists for "just in time" support of DWHP WH care (electronic
consultations). The intervention is technology-supported and delivered virtually. It is being
implemented in a stepwise manner.
Objectives: Facilitators and barriers to use of DWHP Support, and its effect on patient
management are unknown. The investigators hypothesize that DWHP Support will improve the
quality and efficiency of WH care in CBOCs. The specific aims are:
Aim #1: To evaluate the effect of DWHP Support on WH care quality and efficiency, using a
modified stepped wedge design; Aim #2: To explore the impact of DWHP Support in changing DWHP
behavior and self-rated WH knowledge, skills, and self-efficacy; Aim #3: To assess attitudes
about DWHP Support and its use, specialist time for its implementation, and other features
that could influence DWHP Support's effectiveness, sustainability and spread; Aim #4: To
develop tools to measure quality of WH care in VA.
Methods: The investigators will conduct an observational study of DWHP Support for CBOC
DWHPs. The investigators will use a mixed methods analytic approach (combining a modified
stepped wedge quantitative analysis with provider surveys and interviews) to measure the
intervention's effect after 1 year, while also evaluating the implementation process and use
of the intervention. The investigators will use quality assessment methods to translate
existing evidence-based WH performance guidelines into quality measurement tools applicable
to VA WH care.
Anticipated Impact: This proposal aims to evaluate an innovation to improve WH care in CBOCs
that uses a technology-based educational and interactive communication intervention designed
for WH providers. To measure the intervention's effectiveness, this project will develop WH
quality measures that will be valuable tools for other VA efforts to improve WH care. The
findings on effectiveness and implementation could influence VA's approach and use of
technology-supported interventions for other clinical conditions and in other special
populations.
While entitled to receive care equivalent to their male counterparts, women Veterans may
receive lower quality care, in part due to a VA primary care (PC) workforce that has limited
experience caring for women, particularly their gender-specific conditions. This workforce
may be especially challenged in community-based outpatient clinics (CBOCs), where access to
women's health (WH) expertise may not be readily available. CBOC PC providers (PCPs)
typically have small caseloads of women Veterans, making it difficult for these providers to
maintain their WH knowledge and skills. To ensure quality care for women Veterans, VA
mandated designated WH providers (DWHPs) in every VA facility, and instituted intensive
training opportunities-"WH mini-residencies"-for these providers. Although highly valuable in
delivering a standard level of specialized WH training, these one-time trainings are not
sufficient, as knowledge attenuates over time. Serial education re-enforcement over time is
needed to produce and maintain long-term gains in knowledge. Furthermore, additional
supports, such as enhanced communication between PCPs and specialists, are necessary to
achieve and sustain quality gains. To address these issues, VA is implementing a clinical
operations innovation that is designed to improve CBOC-based DWHP delivery of comprehensive
WH care. This innovation (entitled DWHP Support) combines: 1) advanced WH serial
patient-based education that exposes DWHPs, over time, to a depth and breadth of WH cases and
issues (SCAN-ECHO); and 2) interactive communication between CBOC DWHPs and VA Medical
Center-based specialists for "just in time" support of DWHP WH care (electronic
consultations). The intervention is technology-supported and delivered virtually. It is being
implemented in a stepwise manner.
Objectives: Facilitators and barriers to use of DWHP Support, and its effect on patient
management are unknown. The investigators hypothesize that DWHP Support will improve the
quality and efficiency of WH care in CBOCs. The specific aims are:
Aim #1: To evaluate the effect of DWHP Support on WH care quality and efficiency, using a
modified stepped wedge design; Aim #2: To explore the impact of DWHP Support in changing DWHP
behavior and self-rated WH knowledge, skills, and self-efficacy; Aim #3: To assess attitudes
about DWHP Support and its use, specialist time for its implementation, and other features
that could influence DWHP Support's effectiveness, sustainability and spread; Aim #4: To
develop tools to measure quality of WH care in VA.
Methods: The investigators will conduct an observational study of DWHP Support for CBOC
DWHPs. The investigators will use a mixed methods analytic approach (combining a modified
stepped wedge quantitative analysis with provider surveys and interviews) to measure the
intervention's effect after 1 year, while also evaluating the implementation process and use
of the intervention. The investigators will use quality assessment methods to translate
existing evidence-based WH performance guidelines into quality measurement tools applicable
to VA WH care.
Anticipated Impact: This proposal aims to evaluate an innovation to improve WH care in CBOCs
that uses a technology-based educational and interactive communication intervention designed
for WH providers. To measure the intervention's effectiveness, this project will develop WH
quality measures that will be valuable tools for other VA efforts to improve WH care. The
findings on effectiveness and implementation could influence VA's approach and use of
technology-supported interventions for other clinical conditions and in other special
populations.
Inclusion Criteria:
US Department of Veterans Affairs Women's Health primary care provider in who participates
in Veterans Affairs SCAN-ECHO learning sessions or uses Veterans Affairs gynecology
electronic consults.
Exclusion Criteria:
We found this trial at
1
site
West Los Angeles, California 90073
Phone: 310-478-3711
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