Fourth Innovation: I-HEAL's Data-Driven Policy Recommendations

Universal policy mandates for virtual health to enhance healthcare access exist in VA/DOD; however no research exists understanding its successful implementation for persons with TBI morbidity. Implementation of virtual health resources has been a priority initiative for VA and DOD for the past two decades because virtual technologies can reduce barriers to accessing care. For example, over 5.5 million Veterans actively use the VA’s electronic health portal [My HealtheVet MHV)]. Dr. Haun and other virtual health experts in the field have spent more than a decade evaluating user’s experiences and implementing humancentered design (HCD) efforts to support uptake and sustained use of virtual health resources. However, the COVID-19 pandemic shifted to the priority of sustaining access to care, relying heavily on use of virtual health resources.

What had once been an option for accessing care, has become a necessity. During the COVID-19 pandemic, implementation efforts and emergency mandates saw a landmark increase in the use of virtual health resources across all healthcare services. However, the recent universal mandates to increase access do not consider unique needs of populations who may require accommodations for cognitive impairments, including alternative communication approaches for accessing healthcare. As the field of TBI systems of care – and healthcare systems in general – launch into protocols which take a “one model fits all” approach to virtual healthcare resource use, clinicians are identifying barriers that are uniquely presented with V/SM with TBI. To date, there has been little, if any, research focusing on the virtual healthcare resource needs for persons with TBI.

This project proposes to leverage existing data to develop a taxonomy of domains and themes relevant to access to virtual healthcare for persons with TBI morbidity. The study will leverage an existing qualitative dataset examining facilitators and barriers to chronic pain care in persons with TBI. The use of virtual health resources were commonly noted but not the focus of the primary study. This proposal offers a cost-efficient approach that will launch this untapped area of science into a discovery process which can inform a HCD approach to informing recommendations regarding appropriate use of virtual healthcare delivery to persons with TBI. Preliminary review of the relevant dataset indicates a clear need to re-evaluate the data with a lens to assess barriers to use of virtual health resources with persons with TBI.

Although virtual health resource use emerged as a main theme in NIDILRRanalyses, facilitators, and barriers to using virtual healthcare were not explored. The focus of the secondary analysis will be on virtual health resource use in the context of delivering chronic pain care which is the top comorbidity in persons with military TBI. 8 Analysis of this secondary data will inform identification of: (1) necessary virtual health resource accommodations; and (2) policy recommendations needed to determine appropriate virtual health resource use for persons with TBI-related morbidity (e.g., cognitive, physical, behavioral impairments).