# Virtual Care QUERI Program: Implementation of Technology Facilitated Evidence Based Practices to Improve Access to High Quality Care for Rural Veterans

> **NIH VA I50** · VA PUGET SOUND HEALTHCARE SYSTEM · 2021 · —

## Abstract

The Department of Veterans Affairs (VA) cares for 2.7 million Veterans living in rural areas, comprising 32% of
all VA enrollees. Rural and remote Veterans are served by over 1,000 CBOCs that deliver care to 64% of all
VA enrollees. Underperforming CBOCs are the primary deployment setting for the Virtual Care (VC) QUERI
program. Evidence-based practices (EBPs) developed for large VAMCs are often not feasible to deploy in
CBOCs due to staffing constraints. The lack of on-site mental health specialists in CBOCs makes it particularly
difficult to deploy mental health EBPs such as Measurement-Based Care and Trauma-Focused Psychotherapy
for PTSD. As a result, these mental health EBPs are not accessible for many rural and remote Veterans. The
impact goal of the proposed VC QUERI program is to support our operational partners in the regional and
national rollout of evidence-based practices that incorporate virtual care technologies in order to improve
access to high quality care for rural Veterans in underperforming CBOCs. Our operational partners are the
Office of Rural Health, the Office of Connected Care, and the Office of Mental Health and Suicide Prevention.
The specific aims of the VC QUERI are: Aim 1– Develop, evaluate, and refine implementation strategies for
the Office of Rural Health, Office of Connected Care, and the Office of Mental Health and Suicide Prevention
designed to deploy evidence-based practices for rural Veterans that incorporate teleheath, ehealth, and
mhealth. Aim 2– Deploy two evidence-based practices that incorporate virtual care technologies to optimize
reach, adoption, fidelity, clinical effectiveness and sustainability in underperforming CBOCs. Aim 3– Measure
the cost and cost-effectiveness of implementing evidence-based practices that incorporate virtual care
technologies from the perspective of our operational partners.
The evidence-based practices being deployed are Measurement-based care (MBC) and Written Exposure
Therapy (WET). MBC is an evidence-based practice supported by numerous randomized controlled trials.
MBC entails the systematic administration of symptom rating scales and use of the results to drive clinical
decision making at the level of the individual patient. WET is a new brief trauma-focused therapy developed at
the National Center for PTSD that is supported by two randomized controlled trials and is considered a first-line
treatment for PTSD.
Our overall implementation approach has two main steps. The first EBP Adaptation Step will use User
Centered Design methods to make the EBPs more implementable by improving their usability. The adaptation
step will be conducted with a small number of sites, providers and patients who are representative of future
end-users. The second EPB Deployment/Test Step will use more traditional implementation strategies (e.g.,
external facilitation) to deploy the adapted EBP at a larger scale.
The VC QUERI program will have an Implementation Core with: 1) Implementation Team,...

## Key facts

- **NIH application ID:** 10070313
- **Project number:** 1I50HX003202-01
- **Recipient organization:** VA PUGET SOUND HEALTHCARE SYSTEM
- **Principal Investigator:** JOHN C. FORTNEY
- **Activity code:** I50 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-10-01 → 2025-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10070313

## Citation

> US National Institutes of Health, RePORTER application 10070313, Virtual Care QUERI Program: Implementation of Technology Facilitated Evidence Based Practices to Improve Access to High Quality Care for Rural Veterans (1I50HX003202-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10070313. Licensed CC0.

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