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BackgroundCOVID-19 rapidly accelerated the implementation of telemedicine in U.S. Department of Veterans Affairs (VA) specialty care clinics. This mixed-methods study was conducted at a VA medical center to understand the use of telemedicine, and the barriers and facilitators to its implementation, in cardiology outpatient clinics.MethodsQuantitative analyses modeled monthly trends of telemedicine use over 24-months (March 2019-March 2021) with segmented logistic regression and adjusted for socio-demographic predictors of patient-level telemedicine use. Qualitative interviews were conducted (July-October 2020) with eight cardiology clinicians.ResultsAt the onset of COVID-19, likelihood of telemedicine use was ∼12 times higher than it was pre-COVID-19 (p

BackgroundAt the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting nonurgent in-person appointments. Even though the VA was an early adopter of telehealth in the late 1990s, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020.ObjectiveWe compared telehealth service use at a VA Medical Center, Greater Los Angeles across 3 clinics (primary care [PC], cardiology, and home-based primary care [HBPC]) 12 months before and 12 months after the onset of COVID-19 (March 2020).MethodsWe used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of monthly outpatient and telehealth visits, as well as telephone and VA Video Connect encounters were examined for each clinic. Semistructured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes.ResultsPrior to COVID-19, telehealth use was minimal at all 3 clinics, but at the onset of COVID-19, telehealth use increased substantially at all 3 clinics. Telephone was the main modality of patient choice. Compared with PC and cardiology, video-based care had the greatest increase in HBPC. Several important barriers (multiple steps for videoconferencing, creation of new scheduling grids, and limited access to the internet and internet-connected devices) and facilitators (flexibility in using different video-capable platforms, technical support for patients, identification of staff telehealth champions, and development of workflows to help incorporate telehealth into treatment plans) were noted.ConclusionsTechnological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions to improve access to care beyond the pandemic.

PURPOSE Evidence shows the value of home blood pressure (BP) monitoring in hypertension management. Questions exist about how to effectively incorporate these readings into BP follow-up visits. We developed and implemented a tool that combines clinical and home BP readings into an electronic health record (EHR)-integrated visualization tool. We examined how this tool was used during primary care visits and its effect on physician-patient communication and decision making about hypertension management, comparing it with home BP readings on paper. METHODS We video recorded the hypertension follow-up visits of 73 patients with 15 primary care physicians between July 2018 and April 2019. During visits, physicians reviewed home BP readings with patients, either directly from paper or as entered into the EHR visualization tool. We used conversation analysis to analyze the recordings. RESULTS Home BP readings were viewed on paper for 26 patients and in the visualization tool for 47 patients. Access to home BP readings during hypertension management visits, regardless of viewing mode, positioned the physician and patient to assess BP management and make decisions about treatment modification, if needed. Length of BP discussion with the visualization tool was similar to or shorter than that with paper. Advantages of the visualization tool included ease of use, and enhanced and faster sense making and decision making. Successful use of the tool required patients' ability to obtain their BP readings and enter them into the EHR via a portal, and an examination room configuration that allowed for screen sharing. CONCLUSIONS Reviewing home BP readings using a visualization tool is feasible and enhances sense making and patient engagement in decision making. Practices and their patients need appropriate infrastructure to realize these benefits. Key words: patient-generated health data; home blood pressure monitoring; hypertension control; clinical decision support; EHR; health information technology; ergonomics; data visualization; shared decision making, INTRODUCTION Hypertension is a serious, prevalent disease affecting more than 100 million American adults. (1) High blood pressure (BP) contributes 40.6% of the attributable risk for heart and cardiovascular disease [...]

Context: COVID-19 provided an unprecedented opportunity to understand the use of telehealth for opioid use disorder (OUD) treatment in primary care settings. Objective: 1) Assess characteristics associated with having more telehealth vs. in-person visits and 2) understand clinical team members' experiences delivering OUD treatment via telehealth. Study Design: Mixed methods. Analysis: Logistic regression; Inductive qualitative approach. Setting: Two family medicine clinics (1 rural; 1 urban federally-qualified health center (FQHC). Population: EHR data from patients with 31 primary care visit and 31 OUD medication order from 3/8/2020-9/1/2021 (N=741 patients). Semi- structured interviews with clinic team members of OUD treatment programs at each clinic (N=10). Outcomes: 1) Binary variable: 350% of visits via telehealth vs. 350% in-person by patient characteristics and 2) clinical experiences treating OUD via telehealth. Results: Most patients had 31 telehealth visit, with the majority by phone vs. video. Patients in the rural clinic (vs. urban FQHC; OR=0.05; 95% CI:0.03-0.08), those with 31 psychiatric diagnosis (vs. none; OR=0.49, 95% CI:0.29-0.82) and new patients (vs. returning; OR=0.47; 95% CI:0.27-0.83) had lower odds of having more telehealth visits than in-person. Interviews supported quantitative findings. Respondents noted telehealth constraints, including among patients in rural areas with limited/no internet access, those with more psychological burden who tended to respond better to the intangible benefits of in-person visits (e.g., seeing more subtle visual cues), and those who were more socioeconomically disadvantaged who did not always have phone/internet access. Building rapport in telehealth visits was described as being more challenging with newer patients compared to returning patients, though not impossible. Noted benefits of telehealth included convenience and increased flexibility for patients for whom coming to the clinic on a regular basis could be burdensome. Conclusion: Findings revealed differences in preferred delivery mode (i.e., telehealth vs. in-person) and modality (phone vs. video) for treatment by certain patient characteristics. Clinicians identified drawbacks and benefits of use of telehealth to treat OUD. Length of time in OUD program, patient resources, and comorbidities should be considered in determining the most appropriate OUD treatment mode and modality in primary care settings providing care to underserved populations., Presenters Tamar Wyte-Lake, DPT, MPH, Steffani Bailey, PhD, Laurel Hallock Koppelman, Deborah Cohen, PhD, Jennifer Lucas, PhD, Rebecca Cantone, MD, Brian Garvey, MD, MPH, Shannon Williams, MSc, Heather Angier, PhD, [...]

BackgroundThe 'spillover effect' of academic-practice partnerships on hospital nursing staff has received limited attention. In 2007, the Department of Veterans Affairs (VA) created the VA Nursing Academy (VANA) to fund fifteen partnerships between schools of nursing and local VA healthcare facilities. In this paper, we examine the experiences of the VA staff nurses who worked on the units used for VANA clinical training.MethodsWe used survey methods to collect information from staff nurses at all active VANA sites on their characteristics, exposure to the program's clinical training activities, satisfaction with program components, and perspectives of the impact on their work and their own plans for education (N = 314). Our analyses utilized descriptive statistics and bivariate and multivariate regression.ResultsResults show that staff nurses working on VANA units had moderately high levels of exposure to the program's clinical education activities, and most reported positive experiences with those activities. The vast majority (80 %) did not perceive the presence of students as making their work more difficult. Among those who were enrolled or considering enrolling in a higher education program, over a quarter (28 %) said that their VA's participation in VANA had an influence on this decision. The majority of staff nurses were generally satisfied with their experience with the students. Their satisfaction with the program was related to the level or dose of their exposure to it. Those who were more involved were more satisfied. Greater interaction with the students, more information on the program, and a preceptor role were all independently associated with greater program satisfaction.ConclusionsOur study suggests that academic-practice partnerships may have positive spillover effects on staff nurses who work on clinical education units. Further, partnerships may be able to foster positive experiences for their unit nurses by focusing on informing and engaging them in clinical training activities. In particular, our results suggest that academic-practice partnerships should keep unit nurses well informed about program content and learning objectives, encourage frequent interaction with students, involve them in partnership-related unit-based activities, and urge them to become preceptors for the students.

BackgroundThe nursing profession is exploring how academic-practice partnerships should be structured to maximize the potential benefits for each partner. As part of an evaluation of the U.S. Department of Veterans Affairs Nursing Academy (VANA) program, we sought to identify indicators of successful partnerships during the crucial first year.MethodsWe conducted a qualitative analysis of 142 individual interviews and 23 focus groups with stakeholders from 15 partnerships across the nation. Interview respondents typically included the nursing school Dean, the VA chief nurse, both VANA Program Directors (VA-based and nursing school-based), and select VANA faculty members. The focus groups included a total of 222 VANA students and the nursing unit managers and staff from units where VANA students were placed. An ethnographic approach was utilized to identify emergent themes from these data that underscored indicators of and influences on Launch Year achievement.ResultsWe emphasize five key themes: the criticality of inter-organizational collaboration; challenges arising from blending different cultures; challenges associated with recruiting nurses to take on faculty roles; the importance of structuring the partnership to promote evidence-based practice and simulation-based learning in the clinical setting; and recognizing that stable relationships must be based on long-term commitments rather than short-term changes in the demand for nursing care.ConclusionsDeveloping an academic-clinical partnership requires identifying how organizations with different leadership and management structures, different responsibilities, goals and priorities, different cultures, and different financial models and accountability systems can bridge these differences to develop joint programs integrating activities across the organizations. The experience of the VANA sites in implementing academic-clinical partnerships provides a broad set of experiences from which to learn about how such partnerships can be effectively implemented, the barriers and challenges that will be encountered, and strategies and factors to overcome challenges and build an effective, sustainable partnership. This framework provides actionable guidelines for structuring and implementing effective academic-practice partnerships that support undergraduate nursing education.

Abstract AIM This study examines how prior teaching experience and academic training are associated with teaching roles, level of desired support, and satisfaction with the VA Nursing Academy (VANA). BACKGROUND [...]