Role of Site-Visits in Program Evaluation to Improve care of Veterans
Tuesday, November 3, 2015
: 8:45 a.m. - 9:00 a.m.
In 2010 the Veterans Health Administration (VHA) initiated two national initiatives, Electronic Consults (E-Consults) and Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) to increase access to and improve continuity of specialty care services for Veterans, through electronic consultations and videoconferencing sessions with primary care providers (PCPs) and specialists. The goal of this study was to conduct eight site visits in 2013 at VHA Medical Centers implementing the initiatives to describe and assess facilitators and barriers to E-Consult and SCAN-ECHO implementation and adoption. Evaluators from the VHA Specialty Care Evaluation Center conducted interviews and focus groups during site visits with PCPs, specialists, and program managers as well as “walkabouts” to assess cultural behavior and environmental factors at the sites. Evaluators’ field notes and reflections were qualitatively analyzed using inductive and deductive approaches to assess site visit findings and their relationship to previous findings from phone interviews with key stakeholders participating in the initiatives. Evaluators found site visits to be powerful illustrations of how PCPs and specialists utilized initiatives to work collaboratively to find innovative solutions to improve patient care and access. Interviewees described feeling personally empowered; reported increased satisfaction with work environments; felt initiatives attracted new providers and retained current providers; and believed initiatives assisted in communicating new clinical guidelines into practice. They voiced frustration with the difficulty in hiring new personnel for initiative-related positions and lack of sufficient time to attend SCAN-ECHO sessions and complete E-Consults, as well as a desire for additional leadership support to ensure more comprehensive initiative adoption. These results will inform implementation of initiatives at future VHA medical centers.
Implementation of health education strategies, interventions and programs
Describe the context and culture of the environment and experiences of health care providers who participate and implement national technology-based initiatives to improve access to specialty care for Veterans. Identify barriers and facilitators of implementation of and participation in these national initiatives. Assess how national initiatives did or did not work together/complement each other. Develop and identify key tools and components to conduct site visits for program evaluation.
Keyword(s): Veterans' Health, Evaluation
Presenting author's disclosure statement:
Qualified on the content I am responsible for because: I was one of the researchers who conducted site visits as part of this multi-site Department of Veterans Affairs Specialty Care evaluation project and have worked on this project since its inception in 2011. I also conducted many of the phone interviews for the study which occurred prior to the site visits, developed interview guides used for interviews and focus groups, and analyzed data presented in this abstract.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.