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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Receiving the optimized ADviSE Intervention | Experimental | 6 months of selected text messages from a library developed and refined in previous study aims. |
|
| Control period | No Intervention | Usual care. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Clinician Coaching Sessions | Behavioral | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| Veterans' perceptions of the value of their healthcare | Measured by survey at baseline and intervention end | 6 months prior to intervention and 6-months post intervention |
| Measure | Description | Time Frame |
|---|---|---|
| VA Video Connect (VVC) encounters with assigned Patient Aligned Care Team (PACT) | Measured using Corporate Data Warehouse (CDW) data | 6 months prior to intervention and 6-months post intervention |
| Face-to-Face (F2F) encounters with assigned Patient Aligned Care Team (PACT) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jeffrey T Kullgren, MD MPH MS | Contact | (734) 845-5290 | Jeffrey.Kullgren@va.gov | |
| Nora A Metzger, BA MSW | Contact | (734) 222-7682 | nora.metzger2@va.gov |
| Name | Affiliation | Role |
|---|---|---|
| Jeffrey T. Kullgren, MD MPH MS | VA Ann Arbor Healthcare System, Ann Arbor, MI | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| VA Ann Arbor Healthcare System, Ann Arbor, MI | Recruiting | Ann Arbor | Michigan | 48105-2303 | United States |
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| ID | Term |
|---|---|
| D001519 | Behavior |
| D057240 | Patient Preference |
| D003142 | Communication |
| D017060 | Patient Satisfaction |
| ID | Term |
|---|---|
| D000074822 | Treatment Adherence and Compliance |
| D015438 | Health Behavior |
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Stepped wedge cluster randomized controlled trial
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| Personalized text messages to patients | Other | 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. |
|
Measured using CDW data |
| 6 months prior to intervention and 6-months post intervention |
| Telephone encounters with assigned Patient Aligned Care Team (PACT) | Measured using CDW data | 6 months prior to intervention and 6-months post intervention |
| Veterans' satisfaction with healthcare | Measured by survey at baseline and intervention end | 6 months prior to intervention and 6-months post intervention |
| Veterans' preferences for virtual care | Measured by survey at baseline and intervention end | 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 | 6 months prior to intervention and 6 months post intervention |
| Hemoglobin A1c level <8% among Veterans with diabetes | Electronic quality measure (eQM) measured using CDW data | 6 months prior to intervention and 6 months post intervention |
| Blood pressure (BP) < 140/90 among Veterans with diabetes | Electronic quality measure (eQM) measured using CDW data | 6 months prior to intervention and 6 months post intervention |
| Statin use among Veterans with diabetes | Electronic quality measure (eQM) measured using CDW data | 6 months prior to intervention and 6 months post intervention |
| Statin use among Veterans with ischemic heart disease | Electronic quality measure (eQM) measured using CDW data | 6 months prior to intervention and 6 months post intervention |
| Breast cancer screening among female Veterans | Electronic quality measure (eQM) measured using CDW data | 6 months prior to intervention and 6 months post intervention |
| Cervical cancer screening among female Veterans | Electronic quality measure (eQM) measured using CDW data | 6 months prior to intervention and 6 months post intervention |
| Colon cancer screening among Veterans aged 45-75 | Electronic quality measure (eQM) measured using CDW data | 6 months prior to intervention and 6 months post intervention |
| Flu vaccine receipt among Veterans | Electronic quality measure (eQM) measured using CDW data | 6 months prior to intervention and 6 months post intervention |
| Time costs for Veterans | Measured using CDW data | 6 months prior to intervention and 6 months post intervention |
| Travel costs for Veterans | Measured using CDW data | 6 months prior to intervention and 6 months post intervention |
| Copay costs for Veterans | Measured using CDW data | 6 months prior to intervention and 6 months post intervention |