| Summary: | Cheryl Modica,1 Joy H Lewis,2 R Curtis Bay3 1National Association of Community Health Centers, Bethesda, MD, USA; 2Department of Medicine and Public Health, A.T. Still University, School of Osteopathic Medicine, Mesa, AZ, USA; 3Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, USACorrespondence: Cheryl Modica, National Association of Community Health Centers, Inc, 7501 Wisconsin Avenue, Suite 1100W, Bethesda, MD, 20814, USA, Tel +1 301 310 2250, Email cmodica@nachc.orgIntroduction: Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers.Objective: This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven tools and technology, on the performance of clinical and patient experience measures.Methods: A virtual care model, applied using a systems approach offered by the Value Transformation Framework (VTF), was combined with self-care tools and technology in twenty health centers across 17 states to drive improvement efforts. Changes in clinical measures and patient experience were compared.Results: A total of 385 patients were enrolled and 270 (70.1%) completed a baseline visit and at least four virtual visits during the six-month intervention period. Statistically significant improvements were seen in measures for HbA1c, systolic and diastolic blood pressure, and bodyweight. Among the 270 who completed the baseline and at least 4 virtual visits, the percentage up-to-date for colorectal cancer screening increased from 113/270 (41.9%) to 169/270 (62.6%) after six months, p< 0.001, a 20.7% increase. Patients completing the baseline visit and at least 4 virtual visits reported a 10.7% decrease in depression and increased satisfaction with virtual care visits compared to in-person visits (p< 0.001).Conclusion: Health centers applying the Value Transformation Framework’s organizing framework to the use of virtual care models together with patient self-care tools, technology, and education, had improvements in measures for chronic and preventive conditions and patient experience.Plain Language Summary: The Value Transformation Framework (VTF) was designed by the lead author to serve as an organizing framework for health center systems change and advancement toward the Quintuple Aim: improved health outcomes, improved patient experiences, improved staff experiences, reduced costs, and equity. When applied in the health care setting, the VTF translates research, evidence-based solutions, and promising practices into clear and practical steps that health centers can use to achieve value-driven care. In this paper, the authors report on results from a study where the VTF’s organizing approach was combined with evidence-based virtual care models supported by patient self-care tools, technology, and education with improvements seen in measures for colorectal cancer screening, hypertension control, diabetes control, weight, patient reported depression, and patient experience. The action steps taken by health centers participating in this quality improvement project can be replicated by other health centers.The impact of colon cancer, hypertension, diabetes, obesity, and depression, particularly among health center patients, is substantial. Identifying strategies to change health center systems in ways that improve performance is critically important. The authors demonstrated that implementing the VTF can provide health centers with a practical and actionable approach to health center systems change to achieve significant improvements in clinical measurements, patient-reported depression, and patient experience with care.Keywords: vulnerable populations, colorectal cancer screening, hemoglobin A1c, obesity, depression, patient experience
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