As both the largest integrated health system and largest provider of telehealth in the country, the Veterans Health Administration (VHA) has a particular interest in understanding how best to implement and utilize virtual care. VHA has long embraced virtual care as part of its mission to “serve all who have served” regardless of their socioeconomic and geographic circumstances. Having begun conducting “virtual care” in the 1960s when doctors first communicated with patient’s via TV screens,1 VHA has since provided over 2.6 million episodes of care to more than 900,000 Veterans in 20192 and has distributed over 50,000 data- and video-enabled iPads for Veterans throughout the country.3 Virtual care within VHA includes services such as MyHealtheVet secure messaging, the Home Telehealth program that combines case management principles with remote monitoring to improve access and coordinate care, and the VA Video Connect (VVC) video platform for synchronous visits within both specialty and primary care.4 Increasing Veteran access to care via virtual care has been an integral part of VHA’s strategy for improving chronic disease management for a population that is on average older and sicker than their civilian counterparts.5,6 Given the importance that virtual care has for Veteran care even beyond the COVID-19 pandemic, understanding the strengths and limitations associated with synchronous virtual care will be critical in shaping how VHA utilizes virtual care going forward.

Contents

• PREFACE
• ACKNOWLEDGMENTS
• EXECUTIVE SUMMARY
  • INTRODUCTION
  • METHODS
  • RESULTS
  • DISCUSSION
  • ABBREVIATIONS TABLE
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • RISK OF BIAS (QUALITY) ASSESSMENT
  • DATA SYNTHESIS
  • GRADING THE CERTAINTY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION 1
  • KEY QUESTION 2
  • KEY QUESTION 3
  • KEY QUESTION 4
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE BY KEY QUESTION
  • PRIOR SYSTEMATIC REVIEWS
  • HORIZON SCAN
  • CLINICAL AND POLICY IMPLICATIONS
  • LIMITATIONS
  • RESEARCH GAPS
  • CONCLUSIONS
• REFERENCES
• APPENDIX A. SEARCH STRATEGIES
• APPENDIX B. STUDY CHARACTERISTICS TABLE
• APPENDIX C. INTERVENTION CHARACTERISTICS TABLE
• APPENDIX D. REPORTED OUTCOMES TABLE
• APPENDIX E. EXCLUDED STUDIES
• APPENDIX F. PEER REVIEW DISPOSITION

Suggested citation:

Walsh C, Lewinski AA, Rushton S, Soliman D, Carlson SM, Luedke MW, Halpern D, Crowley M, Shaw R, Sharpe J, Alexopoulos AS, Alishahi Tabriz A, Dietch JR, Uthappa DM, Hwang S, Ball Ricks KA, Cantrell S, Kosinski AS, Ear B, Gordon AM, Gierisch JM, Williams JW, Goldstein KM. Virtual Care for the Longitudinal Management of Chronic Conditions. VA ESP Project #09-009; 2021. Posted final reports are located on the ESP search page.

This report was prepared by the Evidence Synthesis Program Center located at the Durham VA Medical Center, Durham, NC, directed by Karen M. Goldstein, MD, MSPH, and Jennifer M. Gierisch, PhD, MPH, and funded by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development.

The findings and conclusions in this document are those of the author(s) who are responsible for its contents and do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.