scholarly journals Implementing Automated Text Messaging for Patient Self-management in the Veterans Health Administration: Qualitative Study Applying the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability Framework

10.2196/31037 ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. e31037
Author(s):  
Vera Yakovchenko ◽  
D Keith McInnes ◽  
Beth Ann Petrakis ◽  
Chris Gillespie ◽  
Jessica M Lipschitz ◽  
...  
Keyword(s):  
Text Messaging ◽  
A Priori ◽  
Scale Up ◽  
Qualitative Evaluation ◽  
Veterans Health Administration ◽  
Self Management ◽  
Veterans Health ◽  
Health Administration ◽  
Novel Technologies ◽  
Additional Support

Background The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management. Objective We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, which is intended to support the evaluation of novel technologies. Methods Semistructured interviews were conducted with 33 staff and 38 patients who were early adopters of the aTS. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS. Results We identified themes across NASSS domains: (1) Condition: The aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefits. (2) Technology: Onboarding of the aTS presented difficulty and the staff had different opinions on incorporating patient-generated data into care planning. (3) Value: Supply-side value relied on the flexibility of the aTS and its impact on staff workload whereas demand-side value was driven by patient perceptions of the psychological and behavioral impacts of the aTS. (4) Adopters: Limited clarity on staff roles and responsibilities presented challenges in incorporating the aTS into clinical processes. (5) Organization: Staff were willing to try the aTS; however, perceptions of leadership support and clinic readiness hindered usage. (6) Wider system: Staff focused on enhancing aTS interoperability with the electronic medical record. (7) Embedding and adaptation over time: The interplay of aTS versatility, patient and staff demands, and broader societal changes in preferences for communicating health information facilitated aTS implementation. Conclusions VHA’s new aTS has the potential to further engage patients and expand the reach of VHA care; however, patients and staff require additional support to adopt, implement, and sustain the aTS. The NASSS highlighted how the aTS can be better embedded into current practices, which patients might benefit most from its functionality, and which aspects of aTS messages are most relevant to self-management. Trial Registration ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349

scholarly journals Implementing Automated Text Messaging for Patient Self-management in the Veterans Health Administration: Qualitative Study Applying the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability Framework (Preprint)

2021 ◽  
Author(s):  
Vera Yakovchenko ◽  
D Keith McInnes ◽  
Beth Ann Petrakis ◽  
Chris Gillespie ◽  
Jessica M Lipschitz ◽  
...  
Keyword(s):  
Text Messaging ◽  
A Priori ◽  
Scale Up ◽  
Qualitative Evaluation ◽  
Veterans Health Administration ◽  
Self Management ◽  
Veterans Health ◽  
Health Administration ◽  
Novel Technologies ◽  
Additional Support

BACKGROUND The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management. OBJECTIVE We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, which is intended to support the evaluation of novel technologies. METHODS Semistructured interviews were conducted with 33 staff and 38 patients who were early adopters of the aTS. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS. RESULTS We identified themes across NASSS domains: (1) Condition: The aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefits. (2) Technology: Onboarding of the aTS presented difficulty and the staff had different opinions on incorporating patient-generated data into care planning. (3) Value: Supply-side value relied on the flexibility of the aTS and its impact on staff workload whereas demand-side value was driven by patient perceptions of the psychological and behavioral impacts of the aTS. (4) Adopters: Limited clarity on staff roles and responsibilities presented challenges in incorporating the aTS into clinical processes. (5) Organization: Staff were willing to try the aTS; however, perceptions of leadership support and clinic readiness hindered usage. (6) Wider system: Staff focused on enhancing aTS interoperability with the electronic medical record. (7) Embedding and adaptation over time: The interplay of aTS versatility, patient and staff demands, and broader societal changes in preferences for communicating health information facilitated aTS implementation. CONCLUSIONS VHA’s new aTS has the potential to further engage patients and expand the reach of VHA care; however, patients and staff require additional support to adopt, implement, and sustain the aTS. The NASSS highlighted how the aTS can be better embedded into current practices, which patients might benefit most from its functionality, and which aspects of aTS messages are most relevant to self-management. CLINICALTRIAL ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349

scholarly journals 412. Assessment and Capability of SARS-CoV-2 Detection in the Veterans Health Administration

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S273-S274
Author(s):  
Aditya Sharma ◽  
Gina Oda ◽  
Mark Holodniy
Keyword(s):  
Average Rate ◽  
Scale Up ◽  
Veterans Health Administration ◽  
The United States ◽  
Turnaround Time ◽  
Veterans Health ◽  
Health Administration ◽  
Maximum Throughput ◽  
Public Health Response ◽  
Specimen Collection

Abstract Background Rapid scale up of testing to detect Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is essential to direct clinical management, optimize infection control actions, and guide public health response efforts to mitigate the spread of Coronavirus Disease 2019 (COVID-19). As the largest integrated health care system in the United States, the Veterans Health Administration (VHA) supported the laboratory-based detection of COVID-19 in a network of 170 medical centers across the country. Methods SARS-CoV-2 testing data from VHA databases were analyzed to assess SARS-CoV-2 detection characteristics. Testing capacity was calculated by multiplying the number of inventoried instruments available for SARS-CoV-2 detection by estimates of instrument-specific maximum throughput with the assumption that instruments would be operational for 16 hours a day and 7 days a week. Results From March 01, 2020 to May 31, 2020, 224,059 Emergency Use Authorization approved RT-PCR tests for SARS-CoV-2 on more than 7 different assay platforms were conducted among 168,761 individuals attending VHA facilities; 10,048 individuals (5.9%) tested positive. During this period, the average rate of tests completed for SARS-CoV-2 increased to more than 4,000 per day (Figure 1A), the percentage of hospitalized individuals who were tested for SARS-CoV-2 increased to approximately 80% (Figure 1B), the median turnaround time from specimen collected to result reported decreased to less than 1 day (Figure 1C), and the percentage of SARS-CoV-2 clinical specimens collected in VHA facilities that were tested at VHA laboratories increased to more than 80% (Figure 1D). Based on inventories of high-throughput and rapid diagnostic instruments (Figure 2), VHA could perform at least 20,000 tests for SARS-CoV-2 per week. Figure 1. Testing metrics for SARS-CoV-2 across VHA facilities. A) Number of daily tests for SARS-CoV-2 completed. B) Percentage of hospitalized Veterans tested for SARS-CoV-2. C). Median turnaround time of completed tests for SARS-CoV-2 from specimen collection to result reported. D) Percentage of SARS-CoV-2 specimens collected in VHA facilities that were tested in VHA laboratories. Figure 2. Distribution of instruments to detect SARS-CoV-2 across VHA facilities. Conclusion Key indicators of laboratory performance for SARS-CoV-2 detection, including test turnaround time, percentage of hospitalized individuals tested, and overall testing volume improved substantially in VHA during the first 3 months of testing during the pandemic. Ongoing efforts seek to enhance just-in-time diagnostic capacity, ensure continuity of specimen collection supplies and laboratory consumables, and identify and minimize gaps in access to testing facilities. Disclosures All Authors: No reported disclosures

scholarly journals Piloting and Evaluating an Automated Text-Messaging System in the Veterans Health Administration

Iproceedings ◽  
2017 ◽  
Vol 3 (1) ◽  
pp. e55 ◽  
Author(s):  
Vera Yakovchenko ◽  
Lorilei Richardson ◽  
Jessica Lipschitz ◽  
Beth Ann Petrakis ◽  
Christopher Gillespie ◽  
...  
Keyword(s):  
Text Messaging ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration

An Intervention With Meaning

Crisis ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 376-383 ◽  
Author(s):  
Brooke A. Levandowski ◽  
Constance M. Cass ◽  
Stephanie N. Miller ◽  
Janet E. Kemp ◽  
Kenneth R. Conner
Keyword(s):  
High Risk ◽  
Qualitative Methodology ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Safety Planning ◽  
Health Administration ◽  
Suicide Method ◽  
Treatment Providers ◽  
Interactive Nature ◽  
Behavioral Health Treatment

Abstract. Background: The Veterans Health Administration (VHA) health-care system utilizes a multilevel suicide prevention intervention that features the use of standardized safety plans with veterans considered to be at high risk for suicide. Aims: Little is known about clinician perceptions on the value of safety planning with veterans at high risk for suicide. Method: Audio-recorded interviews with 29 VHA behavioral health treatment providers in a southeastern city were transcribed and analyzed using qualitative methodology. Results: Clinical providers consider safety planning feasible, acceptable, and valuable to veterans at high risk for suicide owing to the collaborative and interactive nature of the intervention. Providers identified the types of veterans who easily engaged in safety planning and those who may experience more difficulty with the process. Conclusion: Additional research with VHA providers in other locations and with veteran consumers is needed.

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