ABSTRACT
BACKGROUND: The COVID-19 pandemic has dramatically increased the adoption of telehealth, however, the majority of telehealth within the Veterans Health Administration (VHA) has been via phone rather than video. Since video telehealth remains underutilized within the VHA, we conducted a mixed-methods quality improvement (QI) project to increase video telehealth utilization by improving clinic workflow. This work is classified as non research by the Durham VA IRB. METHODS: Primary care visit stop codes for Face to Face (F2F), Phone, and VA Video Connect (VVC) within one clinic in Mid-Atlantic Veterans Integrated Service Network (VISN) 6 from April 2020-December 2021 were pulled from the VHA Clinical Data Warehouse into Power BI software for analysis. Semi-structured qualitative interviews were conducted in January 2021 with key stakeholders to identify barriers and map workflows. An inter professional QI team within the clinic was formed and conducted Plan-Do-Study-Act (PDSA) cycles to increase VVC utilization. VVC utilization was analyzed via a statistical process control chart (SPC). RESULTS: Qualitative interviews identified 6 barriers to VVC use including patient problems with digital connectivity, difficult scheduling workflows, unfamiliarity with software, technical burden on providers, resistance to change, and staff equipment needs. Pre-intervention VVC utilization from April 2020 -January 2021 was 1.1% of all visits. Interventions included staff training, dedicated VVC appointment slots, and standardizing pre-appointment workflow. VVC utilization after project started averaged 4.3% (range 2.8-5.8%). SPC p-chart analysis (Figure 1) shows special cause variation after implementation of dedicated VVC appointment time slots. QI efforts have so far led to ∼560 more VVC visits than otherwise expected had baseline rate continued. CONCLUSIONS: There are many challenges to successfully conducting video telehealth within the VHA. Our experience shows that inter professional QI efforts can improve clinic workflow and increase video telehealth utilization. Future QI efforts are still needed to make video telehealth an efficient part of usual care.