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Care Coordination QUERI Toolkit Facilitates Telehealth Resources for Veterans

A goal of VA Telehealth Services is to understand how telehealth technologies can be used to improve the health of Veterans by providing appropriate and timely care. As part of the Care Coordination QUERI program, led by David Ganz, MD, PhD, the Coordination Toolkit and Coaching (CTAC) project virtually supports patient-aligned care teams (PACTs) to improve patients’ experience of care coordination in outpatient settings, using an online toolkit with or without distance-based coaching. The aims of the CTAC project are to improve Veteran experience of care, improve communication and coordination between PACT providers and specialists (VA and community-based), and reduce inappropriate use of acute care services.

The development of the online Care Coordination Toolkit included the identification of candidate tools using a snowball approach, beginning with existing resources. Three hundred tools were identified and evaluated in three steps:

• Initial review of content for inclusion or exclusion criteria;
• Two-clinician expert review process assessing tool characteristics (i.e., frequency of problem addressed, linkage to patients’ experience of care, effect on practice workflow, and sustainability with existing resources) and assigning each tool a summary rating; and
• Usability interviews with frontline clinicians and staff.

The final set of 18 tools covers six topics: 1) managing referrals to specialty care, 2) medication management, 3) after-visit summary, 4) patient agenda setting, 5) patient pre-visit packet, and 6) provider/health system contact information – and is made available on the VA intranet in collaboration with OSI-VERC (Office of Strategic Integration’s Veterans Engineering Resource Center) at https://vaww.visn10.portal.va.gov/sites/Toolkits/toolkit/Pages/Home.aspx (intranet only) .

Among the resources available in the online toolkit are tools that facilitate timely and virtual access to some VA services. One such resource is a set of educational materials developed at the Mission Valley Clinic of the VA San Diego Healthcare System to support implementation of the AudioRENEWAL system, which allows patients to make an automated request for medication renewals. When patients run out of medication refills, they can use the automated phone system 24/7 to request a new prescription, which then sends an alert in VA’s electronic health record to the appropriate PACT team member. A second tool is “Save-A-Trip,” a one-page, patient-facing educational handout that clinic staff can distribute to patients to help reduce unnecessary calls to the clinic and visits to the Emergency Department. The Save-A-Trip handout illustrates for patients the difference between non-urgent and urgent medical situations, to help the Veteran make more informed decisions about whom to contact at the VA in each situation.

Unplanned in-person interactions that could otherwise be handled remotely can often lead to increased wait times for Veterans. Telehealth technologies along with staff education regarding available virtual resources, like the CTAC online toolkit, have the potential to improve VA care delivery and Veterans’ experience of care by reducing the need for in-person interactions.

For more information, please contact Tanya Olmos-Ochoa, PhD at Tanya.Olmos@va.gov .