Post-Hospitalization Virtual Care Among Veterans with Heart Failure: Examining Experiences, Costs, and Outcomes

Background: The Veterans Health Administration (VA) is rapidly expanding its use of virtual care (the delivery of clinical care via telephone or video) despite a lack of evidence about its equivalence to in-person care. Studies suggest that veterans with heart failure (HF) may be disproportionately and adversely impacted by the widespread use of virtual care, as: (1) data acquired (e.g., vital signs, physical exam, labs) and care delivered during virtual visits is different than what is provided during in-person visits, (2) the majority of adults with HF are >65 years old – an age group that our prior research has shown to have trouble accessing, using, and engaging in virtual care, and (3) Veterans hospitalized for HF have high readmissions rates and may be at high risk of re-hospitalization when using virtual care follow-up. Despite these challenges, virtual care may be beneficial for patients with HF as it may facilitate timely follow-up, more rapid titration of cardiovascular medications, and allow for more frequent monitoring for clinical deterioration. To date, there is no research that comprehensively explores the differences between in-person and virtual care among Veterans with HF. Significance: A better understanding of how virtual care is impacting Veterans with HF is needed. Guided by the Institute for Health Improvement’s Quadruple Aim framework, we propose a mixed-methods assessment to understand the impact of virtual-based post-hospitalization follow-up care among Veterans with HF on health outcomes, utilization, costs, and Veteran and provider experiences. Findings of this research will be significant as they will: (1) fill the data void in virtual care research among a high-risk, high-cost patient population, (2) provide comprehensive outcomes and guidance in how to optimize post-hospitalization HF care in the VA, and (3) directly address key VA HSRD, ORD, OCC, and VA legislative research priorities pertaining to virtual care. Innovation & Impact: This is the first comprehensive study to examine the impact of post-hospitalization virtual care use on patient and provider experiences, health care costs, and health outcomes. This work is innovative in that there are no other health care systems or datasets that would allow for such a comprehensive examination of this issue. Further, the breadth of outcomes (Veteran and provider experiences, health outcomes, utilization, and costs) we are assessing will provide a holistic examination of the impact of virtual care on this population. Specific Aims: (1) Describe practice pattern differences between virtual and in-person post-HF hospitalization follow-up visits, (2) Examine the association of post-HF hospitalization virtual care with utilization, cost, and mortality outcomes, (3) Explore key stakeholder’s recommendations on optimizing post-HF hospitalization follow-up using virtual care. Methodology: This proposal uses a complex mixed-methods study design with advanced statistical techniques and uses comprehensive VA and Medicare data, as well as a robust qualitative approach to interview key stakeholders, including Veterans, clinicians, and VA staff members to accomplish our aims. Next Steps/Implementation: The culmination of findings from this work will be incorporated into a best- practices tool kit that we will actively disseminate with our operations partners (Office of Rural Health, Office of Connected Care, and the National Cardiology Program Offices). Project Number: 1I01HX003855-01A2 | Fiscal Year: 2025 | NIH Institute/Center: Veterans Affairs (VA) | Principal Investigator: Charlie Wray | Institution: VETERANS AFFAIRS MED CTR SAN FRANCISCO, SAN FRANCISCO, CA | Activity Code: I01 | Study Section: HSR-1 Health Care and Clinical Management[HSR1] View on NIH RePORTER: https://reporter.nih.gov/project-details/11102946