The Department of Veterans Affairs (VA) cares for 2.7 million Veterans living in rural areas, comprising 32% of all VA enrollees. Rural and remote Veterans are served by over 1,000 CBOCs that deliver care to 64% of all VA enrollees. Underperforming CBOCs are the primary deployment setting for the Virtual Care (VC) QUERI program. Evidence-based practices (EBPs) developed for large VAMCs are often not feasible to deploy in CBOCs due to staffing constraints. The lack of on-site mental health specialists in CBOCs makes it particularly difficult to deploy mental health EBPs such as Measurement-Based Care and Trauma-Focused Psychotherapy for PTSD. As a result, these mental health EBPs are not accessible for many rural and remote Veterans. The impact goal of the proposed VC QUERI program is to support our operational partners in the regional and national rollout of evidence-based practices that incorporate virtual care technologies in order to improve access to high quality care for rural Veterans in underperforming CBOCs. Our operational partners are the Office of Rural Health, the Office of Connected Care, and the Office of Mental Health and Suicide Prevention. The specific aims of the VC QUERI are: Aim 1? Develop, evaluate, and refine implementation strategies for the Office of Rural Health, Office of Connected Care, and the Office of Mental Health and Suicide Prevention designed to deploy evidence-based practices for rural Veterans that incorporate teleheath, ehealth, and mhealth. Aim 2? Deploy two evidence-based practices that incorporate virtual care technologies to optimize reach, adoption, fidelity, clinical effectiveness and sustainability in underperforming CBOCs. Aim 3? Measure the cost and cost-effectiveness of implementing evidence-based practices that incorporate virtual care technologies from the perspective of our operational partners. The evidence-based practices being deployed are Measurement-based care (MBC) and Written Exposure Therapy (WET). MBC is an evidence-based practice supported by numerous randomized controlled trials. MBC entails the systematic administration of symptom rating scales and use of the results to drive clinical decision making at the level of the individual patient. WET is a new brief trauma-focused therapy developed at the National Center for PTSD that is supported by two randomized controlled trials and is considered a first-line treatment for PTSD. Our overall implementation approach has two main steps. The first EBP Adaptation Step will use User Centered Design methods to make the EBPs more implementable by improving their usability. The adaptation step will be conducted with a small number of sites, providers and patients who are representative of future end-users. The second EPB Deployment/Test Step will use more traditional implementation strategies (e.g., external facilitation) to deploy the adapted EBP at a larger scale. The VC QUERI program will have an Implementation Core with: 1) Implementation Team, 2) Qualitative Summative Evaluation Team, 3) Quantitative Summative Evaluation Team, 4) Economic Evaluation Team, and 5) Administrative Team. The VC QUERI will also have a Rapid Evaluation Core and a Mentoring Core. The VC QUERI will be guided by a Veterans Engagement Panel and a Technical Expert Panel.

I50HX003202

2020-10-01

2025-09-30