In 2014, the VA began a pilot in the northwest to bring team-based primary care gap coverage to sites experiencing provider shortages. Care would follow the VA’s patient-aligned care team (PACT) model, with a twist. The primary care provider, clinical pharmacy specialist (CPS), and primary mental health integration (PCMHI) therapist would be located at a site in Boise. The rest of the PACT team (RN, clinical associate, clerical associate) would be located at the patient VA site. Care would be performed virtually, utilizing teleconferencing equipment, camera otoscopes, and total exam cameras for ear, nose, throat, skin, wound, gait, and other aspects of a primary care exam, as well as counseling.

The concept was so successful that in 2016 the VA decided to expand the V-IMPACT program to every regional area across the enterprise. Currently, there are 11 V-IMPACT Hubs in the United States, providing virtual, team-based primary care. From FY2016 through 2nd quarter FY2018, the VA served over 30,000 Veterans, providing over 58,000 encounters. As the program grew, we discovered that there was a need for RNs in the Hub (provider) site, to offset some of the loss of productivity of the RN and clinical associate at the Spoke (patient) site. This was due to the RN having to perform some level of assessment (auscultation/palpation) when needed, and the clinical associate acting in the role of tele-presenter to assist the provider virtually with the physical exam. The concept of having RNs in the Hubs to assist with mentoring and coaching the Spoke RN in PACT concepts, assisting with panel management and virtual clinical care. Over the last year, the Hubs have collaborated to develop the functional role of the RN in a virtual PACT Hub.

Our poster will present the role of virtual nursing in PACT as follows:
• Train other RNs at the Spoke sites in chronic disease management, a key function of PACT RNs.
• Pull registry data and provide chronic disease management care to veterans.
• Partner with CPS and PCMHI to provide team-based group and individual care to patients with hypertension and diabetes. This interdisciplinary model provides comprehensive education and medication management and helps to achieve improved outcomes.
• Train new Hub providers on virtual PACT processes; i.e. huddles, team meetings, and clinic flow.
• Act as a liaison between Hub and Spoke. They assist with defining and developing processes to provide optimal patient care while achieving effective time management. They are “the glue” that holds the V-IMPACT team together.
• Travel onsite for initial training with the Spoke RN, to train the Spoke in V-IMPACT processes and the PACT model, and to gain an understanding of the clinic flow at the Spoke site.
• Increase provider and patient satisfaction within our Hubs. Greater satisfaction equals better care for patients and less turnover for providers.
• Improve HEDIS measures, by pulling registry data and working directly with patients, providing education, and health coaching to improve outcomes.

Toni Oday BSN, RN, CCM

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