Abstract Veterans in rural areas often lack access to specialized geriatric care and may struggle to reach distant VA facilities for treatment. To better understand the regional needs of aging rural Veterans, this project aims to identify regional needs and resources for geriatrics services to guide future expansion efforts. We describe efforts to identify and map Veterans’ utilization of geriatrics services in three states with large rural populations (Wisconsin, Montana, and Hawaii) to help the VA improve targeting of these resources. By examining utilization data in these three states, we try to pinpoint local areas where there are gaps in services and where Veterans may have unmet geriatric needs. We utilized data from the Geriatric Extended Care Services Data Analysis Center (GECDAC), VA’s comprehensive population-based dataset for geriatric services. To develop these maps, we collected information on over 130,000 Veterans residing in the three states and obtained their sociodemographic variables and risk measures, including frailty, number of falls, Care Assessment Need (CAN) Score (estimated probability of hospitalization or death within 90 days or 1 year), dementia, long-term institutionalization risk, and use of Beers medications (potentially harmful medications for older adults). We observed the number of Veterans using different geriatric services, including geriatric ambulatory care, geriatric inpatient care, residential care, home and community-based care services, personal care services, facility-based care, and Hospice care. These data will form the basis of the “business case” for local leaders and the VA Office of Rural Health to expand geriatric services where they are most needed.

Abstract The need to expand rural geriatric services has received increasing attention within and outside the VHA, yet medical center leaders are often challenged to prioritize expanding these services among myriad competing needs. To better understand potential levers to move rural geriatrics up the priority ladder, we conducted semi-structured interviews with 11 former leaders in the Veterans Health Administration. We explored perspectives on how health system priorities can be aligned to improve the quality and reach of rural geriatric care and solicited best practices for advocating for rural geriatric care at the local, regional and national level. Leaders shared that there was no ‘best way’ to advocate, prompting the development of an advocacy field guide to advance rural geriatric services. The guide draws from our interview data, policy analysis, and best practices in communication and advocacy to help local leaders and champions make a case for expanding rural geriatric resources. The guide describes multiple avenues to purposefully employ “the right strategy, for the right person, at the right time”, including data from mapping local and regional gaps and needs for services, storytelling, relationship building, building a business case, aligning rural geriatrics with regional and national goals, and making geriatrics “personal”. Providing actionable, easy-to-use resources to local champions can support efforts to expand rural geriatric services locally and nationally.

Abstract Background Older rural Veterans often have less access to specialty care services, including geriatrics. The Veterans Health Administration’s (VHA) GRECC Connect is a national program that provides virtual geriatric services for patients and geriatric education for rural clinicians through a case conference series focused on the 5Ms (Mind, Mobility, Medications, Multicomplexity, and Matters Most), a hallmark of high-quality geriatric care. We aimed to measure rural frontline clinicians’ confidence in managing common geriatric problems to inform future education efforts. Methods We conducted an electronic survey-based needs assessment during three case conferences in Spring, 2024. The survey included a brief demographic section and 16 questions on respondents’ confidence addressing clinical issues within the 5Ms (e.g., polypharmacy, falls prevention, goals of care). Results Forty nine percent (211/430) of conference participants completed the survey, including social workers, pharmacists, nurses, and physicians. On average, 69% of respondents reported being ‘confident’ or ‘very confident’ (range 53%-84%) across the 16 questions. Highest confidence levels were in the ‘Matters Most’ domain. Topics rated lower included managing depression, deprescribing, and managing behaviors in patients with dementia. Confidence varied according to health professions and the responsibilities associated with each role. Providers who serve a higher percentage of rural Veterans reported feeling more confident than their urban colleagues across all questions. Conclusion The high level of confidence aligns with findings in the literature that report high self-efficacy ratings in the 5Ms domains among other VA providers and may be related to the VHA’s focus on Age Friendly Health Systems.

Abstract Continual adaptations enhance health care program sustainability amid ongoing health system changes, yet implementation research lacks descriptions of processes to facilitate needed adaptions, particularly for programs implemented in heterogenous settings We employed a three-phase participatory method to explore potential program sustainment strategies for a 19-site Veterans Health Administration program (GRECC Connect) that uses a hub-and-spoke model to expand rural access to geriatric specialty care through telemedicine. First, hub site clinicians and staff completed the Program Sustainment Assessment Tool (PSAT), a publicly available online tool. All sites then participated in a virtual retreat at which potential sustainment strategies, barriers and facilitators to each strategy, the capacity to enact each proposed strategy, and data needed to move forward in choosing a sustainment path were discussed. And finally, sites engaged in a participatory process with their local GRECC Connect teams to draft a site-specific sustainment plan. Proposed sustainment paths included integrating with local or regional clinical services, or mentoring other groups wanting to provide geriatrics telehealth specialty care. Sites varied in their perceived confidence to sustain program activities. Barriers and facilitators to sustainment strategies related to the current level of integration into and relationships with existing clinical services, existing relationships with local and regional VA leadership, knowledge of facility priorities, and perceived capacity to develop their program’s business case. This participatory approach enabled sites to plan the most feasible sustainment strategy for their own site, while using the support, knowledge, and experience of the national GRECC Connect team to do so.

GRECC Connect, a national program with interprofessional teams at urban-based VA medical facilities, partner with VA community-based outpatient clinics (CBOCs) to provide geriatric specialty care via telemedicine to rural, older Veterans. Our QI project explored factors affecting program uptake. February-May 2020 we conducted 50 interviews with CBOC staff across the US; 60–80% of patients were rural/highly rural older Veterans. CBOC staff described social determinants of health negatively impacting telemedicine access. Patients on the edge of the digital divide were at risk of diminished access due to changes in physical, cognitive or emotional health and/or socio-economic status. CBOC staff also described highly rural Veterans caught in the digital divide, without access to reliable internet, devices or computer knowledge/skills; included in this subgroup were Veterans staff described as 'off the grid' due to histories of trauma resulting in mental/physical health challenges, distrust of institutions and technology, and desire for geographic/social isolation. This work differentiated rural, older Veterans GRECC Connect served through telemedicine, from those CBOC partners struggled to reach, even by phone. This digital divide may grow given the aging population. Unique contextual factors influencing telemedicine use among older adult populations are important to elucidate to inform structural supports for enhanced access.

Background: Telemedicine is an important option for rural older adults who often must travel far distances to clinics or forgoessential care. In 2014, the Geriatric Research, Education, and Clinical Centers (GRECC) of the US Veterans Health Administration(VA) established a national telemedicine network called GRECC Connect. This network increased access to geriatric specialtycare for the 1.4 million rural VA-enrolled veterans aged 65 years or older. The use of telemedicine skyrocketed during theCOVID-19 pandemic, which disproportionately impacted older adults, exacerbating disparities in specialty care access asoverburdened systems shut down in-person services. This surge presented a unique opportunity to study the supports necessaryfor those who would forgo telemedicine if in-person care were available. Objective: In spring 2021, we interviewed veterans and their informal caregivers to (1) elicit their experiences attempting toprepare for a video visit with a GRECC Connect geriatric specialist and (2) explore facilitators and barriers to successful engagementin a telemedicine visit. Methods: We conducted a cross-sectional qualitative evaluation with patients and their caregivers who agreed to participate inat least 1 GRECC Connect telemedicine visit in the previous 3 months. A total of 30 participants from 6 geographically diverseGRECC Connect hub sites agreed to participate. Semistructured interviews were conducted through telephone or the VA'svideoconference platform for home telemedicine visits (VA Video Connect) per participant preference. We observed challengesand, when needed, provided real-time technical support to facilitate VA Video Connect use for interviews. All interviews wererecorded with permission and professionally transcribed. A team of 5 researchers experienced in qualitative research analyzedinterview transcripts using rapid qualitative analysis. Results: From 30 participant interviews, we identified the following 4 categories of supports participants described regardingsuccessful engagement in telemedicine, as defined by visit completion, satisfaction, and willingness to engage in telemedicine in the future: (1) caregiver presence to facilitate technology setup and communication; (2) flexibility in visit modality (eg, videofrom home or a clinic or telephone); (3) technology support (eg, determining device compatibility or providing instruction andon-demand assistance); and (4) assurance of comfort with web-based communication, including orientation to features like closedcaptioning. Supports were needed at multiple points before the visit, and participants stressed the importance of eliciting thevarying needs and preferences of each patient-caregiver dyad. Though many initially agreed to a telemedicine visit because ofpandemic-related clinic closures, participants were satisfied with telemedicine and willing to use it for other types of health carevisits

Background Telemedicine is an important option for rural older adults who often must travel far distances to clinics or forgo essential care. In 2014, the Geriatric Research, Education, and Clinical Centers (GRECC) of the US Veterans Health Administration (VA) established a national telemedicine network called GRECC Connect. This network increased access to geriatric specialty care for the 1.4 million rural VA-enrolled veterans aged 65 years or older. The use of telemedicine skyrocketed during the COVID-19 pandemic, which disproportionately impacted older adults, exacerbating disparities in specialty care access as overburdened systems shut down in-person services. This surge presented a unique opportunity to study the supports necessary for those who would forgo telemedicine if in-person care were available. Objective In spring 2021, we interviewed veterans and their informal caregivers to (1) elicit their experiences attempting to prepare for a video visit with a GRECC Connect geriatric specialist and (2) explore facilitators and barriers to successful engagement in a telemedicine visit. Methods We conducted a cross-sectional qualitative evaluation with patients and their caregivers who agreed to participate in at least 1 GRECC Connect telemedicine visit in the previous 3 months. A total of 30 participants from 6 geographically diverse GRECC Connect hub sites agreed to participate. Semistructured interviews were conducted through telephone or the VA’s videoconference platform for home telemedicine visits (VA Video Connect) per participant preference. We observed challenges and, when needed, provided real-time technical support to facilitate VA Video Connect use for interviews. All interviews were recorded with permission and professionally transcribed. A team of 5 researchers experienced in qualitative research analyzed interview transcripts using rapid qualitative analysis. Results From 30 participant interviews, we identified the following 4 categories of supports participants described regarding successful engagement in telemedicine, as defined by visit completion, satisfaction, and willingness to engage in telemedicine in the future: (1) caregiver presence to facilitate technology setup and communication; (2) flexibility in visit modality (eg, video from home or a clinic or telephone); (3) technology support (eg, determining device compatibility or providing instruction and on-demand assistance); and (4) assurance of comfort with web-based communication, including orientation to features like closed captioning. Supports were needed at multiple points before the visit, and participants stressed the importance of eliciting the varying needs and preferences of each patient-caregiver dyad. Though many initially agreed to a telemedicine visit because of pandemic-related clinic closures, participants were satisfied with telemedicine and willing to use it for other types of health care visits. Conclusions To close gaps in telemedicine use among rural older adults, supports must be tailored to individuals, accounting for technology availability and comfort, as well as availability of and need for caregiver involvement. Comprehensive scaffolding of support starts well before the first telemedicine visit.

BACKGROUND:Half of the 4.7 M veterans who reside in rural communities and rely on U.S. Department of Veterans Affairs (VA) health care are older (≥65). Their rurality presents unique challenges, including a shortage of clinicians skilled in geriatric medicine. Community-based outpatient clinics (CBOCs) help extend VA's geographic reach but are typically located in under-resourced settings. Telemedicine may increase access to care, but little is known about CBOCs' capacity to leverage telemedicine to meet older patients' needs. We identified organizational barriers and facilitators to the use of geriatric telemedicine specialty care from the perspective of rural clinicians and staff. METHODS:From February-April 2020, we interviewed CBOC clinicians and staff (N = 50) from 13 rural CBOCs affiliated with four VA Geriatric Research Education and Clinical Centers. Semi-structured interviews addressed patient population characteristics; CBOC location, staffing, and in-house resources; use of VA specialty care services; and telemedicine use. We developed a codebook using an iterative process and Gale's Framework Method thematically organize and analyze data. RESULTS:Respondents perceived that their CBOCs serve a predominantly older patient population. Four characteristics enabled CBOCs to offer geriatric telemedicine specialty care: partnerships with larger VA Medical Center teams; social worker/telehealth clinical technician knowledge of geriatrics and telehealth resources; periodic outreach/education from geriatric specialists; and routine use of other telehealth services. Barriers included: constraints on clinic space and unstable internet for telemedicine visits; staffing challenges leading to limited familiarity with telemedicine resources; and clinician and staff perceptions of older veterans' preference for in-person visits. CONCLUSIONS:Telemedicine is an important modality to enhance access to care for an increasingly older and medically complex patient population. Although rural CBOCs provide a large portion of care to VA's growing geriatric population, staff are insufficiently trained in geriatrics, work in resource-poor settings, and are largely unaware of VA telemedicine programs designed to support them.

BackgroundQualitative health services research often relies on semistructured or in-depth interviews to develop a deeper understanding of patient experiences, motivations, and perspectives. The quality of data gathered is contingent upon a patient’s recall capacity; yet, studies have shown that recall of medical information is low. Threats to generating rich and detailed interview data may be more prevalent when interviewing older adults. ObjectiveWe developed and studied the feasibility of using a tool, Remembering Healthcare Encounters Visually and Interactively (REVISIT), which has been created to aid the recall of a specific telemedicine encounter to provide health services research teams with a visual tool, to improve qualitative interviews with older adults. MethodsThe REVISIT visual appointment summary was developed to facilitate web-based interviews with our participants as part of an evaluation of a geriatric telemedicine program. Our primary aims were to aid participant recall, maintain focus on the index visit, and establish a shared understanding of the visit between participants and interviewers. The authors’ experiences and observations developing REVISIT and using it during videoconference interviews (N=16) were systematically documented and synthesized. We discuss these experiences with REVISIT and suggest considerations for broader implementation and future research to expand upon this preliminary work. ResultsREVISIT enhanced the interview process by providing a focus and catalyst for discussion and supporting rapport-building with participants. REVISIT appeared to support older patients’ and caregivers’ recollection of a clinical visit, helping them to share additional details about their experience. REVISIT was difficult to read for some participants, however, and could not be used for phone interviews. ConclusionsREVISIT is a promising tool to enhance the quality of data collected during interviews with older, rural adults and caregivers about a health care encounter. This novel tool may aid recall of health care experiences for those groups for whom it may be more challenging to collect accurate, rich qualitative data (eg, those with cognitive impairment or complex medical care), allowing health services research to include more diverse patient experiences.

AbstractObjectiveExplore the perceived benefits of a Veterans Health Administration (VHA) geriatric specialty telemedicine service (GRECC Connect) among rural, older patients and caregivers to contribute to an assessment of its quality and value.Data SourcesIn Spring 2021, we interviewed a geographically diverse sample of rural, older patients and their caregivers who participated in GRECC Connect telemedicine visits.Study DesignA cross‐sectional qualitative study focused on patient and caregiver experiences with telemedicine, including perceived benefits and challenges.Data CollectionWe conducted 30 semi‐structured qualitative interviews with rural, older (≥65) patients enrolled in the VHA and their caregivers via videoconference or phone. Interviews were recorded, transcribed, and analyzed using a rapid qualitative analysis approach.Principal FindingsParticipants described geriatric specialty telemedicine visits focused on cognitive assessments, tailored physical therapy, medication management, education on disease progression, support for managing multiple comorbidities, and suggestions to improve physical functioning. Participants reported that, in addition to prescribing medications and ordering tests, clinicians expedited referrals, coordinated care, and listened to and validated both patient and caregiver concerns. Perceived benefits included improved patient health; increased patient and caregiver understanding and confidence around symptom management; and greater feelings of empowerment, hopefulness, and support. Challenges included difficulty accessing some recommended programs and services, uncertainty related to instructions or follow‐up, and not receiving as much information or treatment as desired. The content of visits was well aligned with the domains of the Age‐Friendly Health Systems and Geriatric 5Ms frameworks (Medication, Mentation, Mobility, what Matters most, and Multi‐complexity).ConclusionsAlignment of patient and caregiver experiences with widely‐used models of comprehensive geriatric care indicates that high‐quality geriatric care can be provided through virtual modalities. Additional work is needed to develop strategies to address challenges and optimize and expand access to geriatric specialty telemedicine.

BACKGROUND:Homeless and marginally housed (HAMH) individuals experience significant health disparities compared to housed counterparts, including higher hepatitis C virus (HCV) rates. New direct-acting antiviral (DAA) medications dramatically increased screening and treatment rates for HCV overall, but inequities persist for HAMH populations.OBJECTIVE:This study examines the range of policies, practices, adaptations, and innovations implemented by Veteran Affairs Medical Centers (VAMCs) in response to Veterans Health Administration (VHA)'s 2016 HCV funding allocation to expand provision of HCV care.DESIGN:Ethnographic site visits to six US VAMCs varying in size, location, and availability of Homeless Patient-Aligned Care Teams. Semi-structured qualitative interviews informed by the HCV care continuum were conducted with providers, staff, and HAMH patients to elicit experiences providing and receiving HCV care. Semi-structured field note templates captured clinical care observations. Interview and observation data were analyzed to identify cross-cutting themes and strategies supporting tailored HCV care for HAMH patients.PARTICIPANTS:Fifty-six providers and staff working in HCV and/or homelessness care (e.g., infectious disease providers, primary care providers, social workers). Twenty-five patients with varying homeless experiences, including currently, formerly, or at risk of homelessness (n=20) and stably housed (n=5).KEY RESULTS:All sites experienced challenges with continued engagement of HAMH individuals in HCV care, which led to the implementation of targeted care strategies to better meet their needs. Across sites, we identified 35 unique strategies used to find, engage, and retain HAMH individuals in HCV care.CONCLUSIONS:Despite highly effective, widely available HCV treatments, HAMH individuals continue to experience challenges accessing HCV care. VHA's 2016 HCV funding allocation resulted in rapid adoption of strategies to engage and retain vulnerable patients in HCV treatment. The strategies identified here can help healthcare institutions tailor and target approaches to provide sustainable, high-quality, equitable care to HAMH individuals living with HCV and other chronic illnesses.

Abstract Innovative care models for older adults such as non-institutional and home-based care have the potential to improve quality and efficiency of healthcare, but adoption of these models requires resources from health systems. Health systems leaders can influence the relative priority of geriatric care and associated resource allocation. This influence is especially important for areas with limited resources such as in rural areas. We interviewed recently retired health system leaders about their experience and how priorities in health systems can be aligned to improve the quality and reach of geriatric care. We conducted qualitative interviews with 10 participants (40% female) using a snowball sampling strategy of geographically diverse, retired hospital, regional, and national leaders in the Veteran Healthcare system, the largest single-payer system in the US. Participants described how they managed myriad competing health system priorities by weighing and devoting attention and time to tackle the crises of the day, the numerous national mandates and directives, and the goals for the local hospital or system, as seen from their own perspectives. Alignment with performance metrics provides strong impetus for some health system leaders to determine their priorities. Incentives to encourage health systems leaders to prioritize and allocate resources aimed at long-term improvements in care could be important. Additionally, building relationships and maintaining trust amongst partners across facilities and offices is critical to initiating and growing geriatrics programs. This work highlights that influence must work on multiple levels to effect change in prioritization of care for older adults.

Background and Objectives Participatory implementation methods are needed in geriatric health care to improve care and services for a growing population of older adults. We describe an efficient participatory approach to improve uptake of Geriatric Research Education and Clinical Center (GRECC) Connect, a national geriatrics outpatient consultation service using telehealth technology to connect geriatric specialists to rural, older veterans though community-based clinics. Research Design and Methods We designed a three-phase participatory method to identify high-priority implementation strategies to support the uptake of GRECC Connect. We used the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change (CFIR-ERIC) Strategy Matching Tool to derive expert-recommended implementation strategies informed by qualitative interviews with both GRECC Connect staff and clinicians at community-based clinics. We engaged expert panelists in a participatory two-step modified e-Delphi process using confidential surveys and discussion to prioritize strategies nationally. Results Qualitative interviews revealed barriers, facilitators, and recommendations for program uptake. Many strategies recommended by CFIR-ERIC addressed multiple barriers but needed to be tailored to our specific context. In our two-step e-Delphi process, expert panelists shared previous experience with the strategies presented, views on the importance and feasibility of each, and arrived at a consensus about which strategies to prioritize nationally. Discussion and Implications We demonstrate the feasibility and benefits of engaging subject matter experts to identify strategies to be tested on a national level. Future considerations include weighting of survey responses, accounting for regional differences, and sensitivity of Likert scales used in the e-Delphi process.

Background Despite increasing commitment to patient engagement in research, evaluation of the impact of these efforts on research processes, products, and teams is limited. Objective To explore the impacts of engaging patients as consultants to research studies by examining the experiences, impacts, and lessons learned from a program facilitating patient engagement at a Veterans Health Administration research center. Design We developed a logic model to articulate the activities being implemented to support patient engagement and their anticipated outcomes. Then, we conducted qualitative, semi-structured interviews with participants in the local Veteran Consulting Network to qualitatively explore these outcomes. Participants Twelve researchers and eleven Veteran patients with experience working on at least one grant or funded study. Approach Interview transcripts were inductively coded using a consensus-based approach. Findings were synthesized using framework analysis and mapped back onto our logic model of expected patient engagement impacts. Key Results Patient engagement improved the perceived quality and relevance of research studies as patient consultants challenged researchers’ assumptions about patient populations and clinical contexts and gave feedback that helped improve the feasibility of proposed grants, readability of study materials, comprehensiveness of study assessments, and cultural sensitivity and relevance of interventions. Patient engagement also had personal benefits to researchers and patients. Researchers reported improved communication skills and higher job satisfaction. Patients reported a sense of purpose and satisfaction from their work with greater awareness of and appreciation for research. Conclusions Engaging patients in research can have multiple benefits to the people and work involved. Our evaluation process can serve as a template for other organizations to plan for and assess the impact of their own patient engagement programs. Creating logic models and updating them based on feedback from program users make engagement goals explicit, help verify expected mechanisms to achieve impact, and facilitate organizational learning.

Background:The Veterans Health Administration (VA) is undergoing a transformation in how healthcare is organized and provided. This transformation to a Whole Health System of Care encompasses the integration of complementary and integrative health services, education, and Whole Health coaching to develop Veterans' self-care skills. During the COVID-19 pandemic, these services were provided via telehealth (tele-WH). Objective:We sought to understand Veteran and provider perspectives on how tele-WH impacts Veteran engagement in Whole Health-aligned services and the impact on their well-being. Methods:Semi-structured interviews were conducted with 51 providers who delivered tele-WH at 10 VA Medical Centers (VAMCs) and 19 Veterans receiving tele-WH at 6 VAMCs. Participants were asked about their experiences with tele-WH, what they perceived to be the impact of tele-WH on Veterans, and their preferences moving forward. Interviews were transcribed, and a content analysis was performed using a rapid approach. Results:We identified 3 major themes that describe the perceived impact of tele-WH on Veterans. These include: (1) increased use of Whole Health-aligned services; (2) deeper engagement with Whole-Health aligned services; and (3) improvements in social, psychological, and physical well-being. Conclusion:Tele-WH is perceived to be a strong complement to in-person services and is a promising mechanism for improving engagement with Whole Health-aligned services and promoting Veteran well-being. Future research is needed to measure outcomes identified in this study and to support more equitable access to telehealth for all.

Abstract Telemedicine is critical to extending healthcare’s reach to rural older adults with complex medical needs, yet concerns remain about feasibility and acceptability for this population and their caregivers. We interviewed 30 rural Veterans ≥65 years old and/or their caregivers (n=21) about their experiences with video or telephone visits as part of an evaluation of Virtual Geriatrics, a network of Veterans Affairs tele-geriatric care hubs. Interviews were recorded, transcribed, and analyzed using rapid qualitative analysis. Caregivers deemed telemedicine a convenient option that prevented burdensome travel to remote specialists, facilitated caregiver involvement in visits, and matched quality of in-person visits. Caregivers often managed technology, enabling their loved one to participate in video visits. Telephone visits, while convenient, sometimes caused missed physical cues and hearing challenges which led providers to lean on caregiver communication. Our findings suggest telemedicine is feasible and acceptable for delivery for geriatrics care among rural adults and their caregivers.

BACKGROUND:The US Veterans Health Administration (VA) is transforming its healthcare system to create a Whole Health System (WHS) of care. Akin to such reorganization efforts as creating patient-centered medical homes and primary care behavioral health integration, the WHS goes beyond by transforming the entire system to one that takes a proactive approach to support patient and employee health and wellness. The SARS-CoV-2 pandemic disrupted the VA's healthcare system and added stress for staff and patients, creating an exogenous shock for this transformation towards a WHS.OBJECTIVE:We examined the relationship between VA's WHS transformation and the pandemic to understand if transformation was sustained during crisis and contributed to VA's response.METHODS:Qualitative interviews were conducted as part of a multi-year study of WHS transformation. A single multi-person interview was conducted with 61 WHS leaders at 18 VA Medical Centers, examining WH transformation and use during the pandemic. Data were analyzed using rapid directed content analysis.RESULTS:While the pandemic initially slowed transformation efforts, sites intentionally embraced a WH approach to support patients and employees during this crisis. Efforts included conducting patient wellness calls, and, for patients and employees, promoting complementary and integrative health therapies, self-care, and WH concepts to combat stress and support wellbeing. A surge in virtual technology use facilitated innovative delivery of complementary and integrative therapies and promoted continued use of WH activities.CONCLUSION:The pandemic called attention to the need for healthcare systems to address the wellbeing of both patients and providers to sustain high quality care delivery. At a time of crisis, VA sites sustained WH transformation efforts, recognizing WH as one strategy to support patients and employees. This response indicates cultural transformation is taking hold, with WH serving as a promising approach for promoting wellbeing among patients and employees alike.

Abstract The VA Office of Rural Health-funded GRECC Connect program uses telehealth modalities to provide geriatric specialty care to rural older veterans and education to clinicians in VA Community-based outpatient clinics (CBOCs). Qualitative evaluation of GRECC Connect has included interviews with three stakeholder groups: geriatrics specialty teams at 15 hub medical centers, rural CBOC staff, and patients/family caregivers. CBOC staff interviews included 50 individuals from 13 different CBOCs. Staff roles included clinic managers, social workers, psychologists, physicians, nurses, and telehealth technicians. Older veterans who had recently been involved in a GRECC Connect video visit were also invited to share their views on the visit. By including multiple perspectives on the program, we are better positioned to increase reach, access, and improve care for older rural veterans.