Evaluation of the Veterans Health Administration's Specialty Care Transformational Initiatives to Promote Patient-Centered Delivery of Specialty Care: A Mixed-Methods Approach.
Veteran's Affairs Office of Specialty Care (OSC) launched four national initiatives (Electronic-Consults [e-Consults], Specialty Care Access Networks-Extension for Community Healthcare Outcomes [SCAN-ECHO], Mini-Residencies, and Specialty Care Neighborhood) to improve specialty care delivery and funded a center to evaluate the initiatives.



The evaluation, guided by two implementation frameworks, provides formative (administrator/provider interviews and surveys) and summative data (quantitative data on patterns of use) about the initiatives to OSC.



Evaluation of initiative implementation is assessed through CFIR (Consolidated Framework for Implementation Research)-grounded qualitative interviews to identify barriers/facilitators. Depending on high or low implementation, factors such as receiving workload credit, protected time, existing workflow/systems compatibility, leadership engagement, and access to information/resources were considered implementation barriers or facilitators. Findings were shared with OSC and used to further refine implementation at additional sites. Evaluation of other initiatives is ongoing.



The mixed-methods approach has provided timely information to OSC about initiative effect and impacted OSC policies on implementation at additional sites.
1 VA Eastern Colorado Healthcare System , Denver, Colorado.
Katherine M
KM
Williams
2 Louis Stokes Cleveland VA Medical Center , Cleveland, Ohio.|3 Office of Specialty Care and Specialty Care Transformation , Washington, D.C.
Susan
S
Kirsh
2 Louis Stokes Cleveland VA Medical Center , Cleveland, Ohio.
David
D
Aron
4 VA Puget Sound Healthcare System , Seattle, Washington.
David
D
Au
4 VA Puget Sound Healthcare System , Seattle, Washington.
Christian
C
Helfrich
1 VA Eastern Colorado Healthcare System , Denver, Colorado.|5 University of Colorado Denver , Denver, Colorado.
Anne
A
Lambert-Kerzner
6 VA Ann Arbor Healthcare System , Ann Arbor, Michigan.
Julie
J
Lowery
1 VA Eastern Colorado Healthcare System , Denver, Colorado.|5 University of Colorado Denver , Denver, Colorado.
Catherine
C
Battaglia
3 Office of Specialty Care and Specialty Care Transformation , Washington, D.C.
Glenn D
GD
Graham
3 Office of Specialty Care and Specialty Care Transformation , Washington, D.C.
Michael
M
Doukas
3 Office of Specialty Care and Specialty Care Transformation , Washington, D.C.
Rajiv
R
Jain
1 VA Eastern Colorado Healthcare System , Denver, Colorado.|5 University of Colorado Denver , Denver, Colorado.
P Michael
PM
Ho
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000458:organization & administration*; D017216:Telemedicine / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
evaluation; healthcare delivery; patient centered care; specialty care; telemedicine