eHealth Partnered Evaluation Initiative

Not Applicable

Completed

• Conditions: Non-secure Message Senders
• Interventions: Behavioral: Supported adoption intervention; Behavioral: Active comparator control

• Registration Number: NCT02665468
• Lead Sponsor: VA Office of Research and Development

Brief Summary

On October 1, 2016, the VHA Office of Telehealth and the Connected Health Office will merge to create a single entity that will be responsible for the implementation and evaluation of eHealth technologies across the healthcare system. In an effort to successfully fulfill its mission, the new combined Connected Health/Telehealth Office is pledging $1,100,000 for an eHealth Partnered Evaluation Initiative (PEI) to support the further implementation of eHealth technologies across VHA, and to measure their impacts on dimensions of access and other outcomes. Developed in close consultation with leadership of the new office, the proposed objectives of the eHealth PEI are to (1) implement a patient-level "supported adoption intervention" for secure messaging and evaluate the impact of secure messaging use through a rapid, one-year randomized trial; and (2) evaluate the initial rollout of VHA's automated telehealth text messaging system to Veterans and clinical team members.

Detailed Description

eHealth is a model for the delivery and receipt of healthcare services with an expanding evidence base that suggests great potential to increase access and support the transition from episodic to continuous care. In this model, patients, their families, and clinical team members use eHealth technologies that support functions (e.g., communication, behavior support, transactions) that are critical to disease prevention and health management which in turn influences behaviors, processes and outcomes.

In October 2016, the existing Office of Telehealth and the Connected Health Office will merge to create a single Office to oversee the implementation and evaluation of eHealth technologies across VHA. The new combined Connected Health/Telehealth Office will manage the full spectrum of technologies included in the current Offices of Telehealth (e.g., clinical video telehealth, home telehealth, tele-ICU) and Connected Health (e.g., patient portal, secure messaging, mobile apps), as well as new technologies that span these offices (such as the new Automated Telehealth Texting System). Recognizing the importance of rigorous evaluation to its mission, the Connected Health/Telehealth Office is pledging funds for an eHealth Partnered Evaluation Initiative (PEI) to support the further implementation of eHealth technologies across VHA, and to measure their impacts on dimensions of access, as well as Veteran and clinical team experiences, healthcare processes, and Veteran health outcomes.

Developed in close consultation with Connected Health/Telehealth Office leadership, the proposed objectives of the eHealth PEI are to (1) implement a patient-level "supported adoption intervention" for secure messaging and evaluate the impact of secure messaging use through a rapid, one-year randomized trial; and (2) evaluate the initial rollout of VHA's automated telehealth text messaging system to Veterans and clinical team members. The evaluation work associated with each of these two objectives will be guided by the Practical, Robust Implementation and Sustainability Model (PRISM).

The implementation and evaluation of eHealth technologies is not just the mission of the new Connected Health/Telehealth Office, it is also the vision of VHA. In addition to addressing the needs of the investigators' operational partner, the aforementioned objectives map to key strategies and transformational actions detailed in the Blueprint for Excellence, and align with a recently developed Virtual Access Strategy Document intended to guide the efforts of the Connected Health/Telehealth Office. The proposed eHealth PEI team includes leadership and investigators from the eHealth Quality Enhancement Research Initiative (QUERI) who are recognized authorities in informatics, implementation science, and mixed methods evaluation, and have longstanding, collaborative relationships with constituents in the Connected Health/Telehealth Office.

Study Timeline

• Study First Submitted: 2016-01-05
• Study First Submitted QC: 2016-01-22
• Study First Posted: 2016-01-27
• Study Start: 2016-02-01
• Primary Completion: 2016-10-31
• Study Completion: 2017-09-30
• Results First Submitted: 2017-10-25
• Status Verified: 2018-01
• Results First Submitted QC: 2018-10-09
• Last Update Submitted: 2018-10-09
• Results First Posted: 2019-02-18
• Last Update Posted: 2019-02-18

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 1196

Inclusion Criteria

• Authenticated My HealtheVet users who have not sent a secure message
• Active patients who have an appointment scheduled in the following year

Read More

Exclusion Criteria

• Authenticated My HealtheVet users who have sent a secure message
• Inactive patients (who do not have an appointment scheduled in the following year)

Read More

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm 1: Supported Adoption Intervention (SAI)	Supported adoption intervention	Supported adoption intervention
Arm 2: General wellness information	Active comparator control	General wellness information

Primary Outcome Measures

Name	Time	Method
Change in Rate of Use	Baseline and Six months	Measure the change in rate of use of secure messaging in intervention versus control Veterans, reported as participants in each arm that sent a secure message during study period.

Secondary Outcome Measures

Name	Time	Method
Patient Self-reported Access to Communication	Six month follow-up	To explore the impact of secure messaging use on healthcare encounters, the investigators will compare the responses of each arm at 6-month follow-up assessment for Patient Self-reported Access to communication using 2 Questions adapted from the Survey of Healthcare Experience of Patients Scale which inquires, "How easy is it for you to communicate with your doctor when you need to?" and, "How easy is it for you to get to see your nurse when you need to?" Responses to scale were 1= "Never", 2= "Sometimes", 3= "Usually", 4= "Always"; where "Always" was the best score.
Care Coordination: Patient Assessment of Chronic Illness Care	Six month follow-up	To explore the impact of secure messaging use on healthcare encounters, the investigators will use the Patient Assessment of Chronic Illness Care (PACIC) designed to assess patients' perceptions of the degree to which their care experiences are consistent with the chronic care model and includes subscale scores for patient activation, goal setting/tailoring, and follow-up/coordination. Investigators compared arms at 6-month follow-up using scale 0 (not a problem) - 4 (very big problem), where 0 indicates the desired response.
Physician Accessibility and Engagement	Six months	To explore the impact of secure messaging use on healthcare encounters, the investigators will compare each arm at 6-month follow-up assessment with responses from Health Care Climate Questionnaire (HCCQ), a 15-item scale adapted to assess the degree to which patient healthcare provider is accessible and supportive (taking the participant's perspective, encouraging and answering questions, supporting their plans) This is a Likert scale ranging from 1 = "Strongly Disagree" to 7 = "Strongly Agree"; where in all but one question - 1 = "Strongly Agree" is the desired response. Responses were totaled, inverting the one question and mean was determined.

Trial Locations

Locations (4)

Birmingham VA Medical Center, Birmingham, AL; 🇺🇸 Birmingham, Alabama, United States

Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; 🇺🇸 Bedford, Massachusetts, United States

VA Salt Lake City Health Care System, Salt Lake City, UT; 🇺🇸 Salt Lake City, Utah, United States

VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA; 🇺🇸 Pittsburgh, Pennsylvania, United States