1. US Department of Veterans Affairs. Office of Rural Health Annual report: Thrive 2016. https://www.ruralhealth.va.gov/docs/ORH2016Thrive508_FINAL.pdf. Accessed September 10, 2019.

2. Holder KA. Veterans in Rural America: 2011–2015. US Census Bureau: Washington, DC; 2016. American Community Survey Reports, ACS-36.

3. US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce, National Center for Health Workforce Analysis.2017. National and regional projections of supply and demand for geriatricians: 2013-2025. https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/GeriatricsReport51817.pdf. Published April 2017. Accessed September 10, 2019.

4. Peterson L, Bazemore A, Bragg E, Xierali I, Warshaw GA. Rural–urban distribution of the U.S. geriatrics physician workforce. J Am Geriatr Soc. 2011;59(4):699-703.

5. Lindeman D. Interview: lessons from a leader in telehealth diffusion: a conversation with Adam Darkins of the Veterans Health Administration. Ageing Int. 2010;36(1):146-154.

6. Darkins A, Foster L, Anderson C, Goldschmidt L, Selvin G. The design, implementation, and operational management of a comprehensive quality management program to support national telehealth networks. Telemed J E Health. 2013;19(7):557-564.

7. US Department of Veterans Affairs. Clinical video telehealth into the home (CVTHM)toolkit for providers. https://www.mirecc.va.gov/visn16//docs/CVTHM_Toolkit.pdf. Accessed September 10, 2019.

8. Darkins A. Telehealth services in the United States Department of Veterans Affairs (VA). https://myvitalz.com/wp-content/uploads/2016/07/Telehealth-Services-in-the-United-States.pdf. Published July 2016. Accessed September 10, 2019.

9. US Department of Veterans Affairs. VA announces telemental health clinical resource centers during telemedicine association gathering [press release]. https://www.va.gov/opa/pressrel/includes/viewPDF.cfm?id=2789. Published May 16, 2016. Accessed September 10, 2019.

10. Hung WW, Rossi M, Thielke S, et al. A multisite geriatric education program for rural providers in the Veteran Health Care System (GRECC Connect). Gerontol Geriatr Educ. 2014;35(1):23-40.

11. Kramer BJ. The VA geriatric scholars program. Fed Pract. 2015;32(5):46-48.

12. Kramer BJ, Creekmur B, Howe JL, et al. Veterans Affairs Geriatric Scholars Program: enhancing existing primary care clinician skills in caring for older veterans. J Am Geriatr Soc. 2016;64(11):2343-2348.

13. Powers BB, Homer MC, Morone N, Edmonds N, Rossi MI. Creation of an interprofessional teledementia clinic for rural veterans: preliminary data. J Am Geriatr Soc. 2017;65(5):1092-1099.

14. Wright SM, Hedin SC, McConnell M, et al. Using shared decision-making to address possible overtreatment in patients at high risk for hypoglycemia: the Veterans Health Administration’s Choosing Wisely Hypoglycemia Safety Initiative. Clin Diabetes. 2018;36(2):120-127.

15. Chang W, Homer M, Rossi MI. Use of clinical video telehealth as a tool for optimizing medications for rural older veterans with dementia. Geriatrics (Basel). 2018;3(3):pii E44.

16. US Department of Veterans Affairs, Office of Rural Health. Rural promising practice issue brief: GRECC Connect Project: connecting rural providers with geriatric specialists through telemedicine. https://www.ruralhealth.va.gov/docs/promise/2017_02_01_Promising%20Practice_GRECC_Issue%20Brief.pdf. Published February 2017. Accessed September 10, 2019.

17. US Department of Veterans Affairs, Office of Public and Intergovernmental Affairs. VA expands telehealth by allowing health care providers to treat patients across state lines [press release]. https://www.va.gov/opa/pressrel/pressrelease.cfm?id=4054. Published May 11, 2018. Accessed September 10, 2019.

18. US Department of Veterans Affairs. Department of Veterans Affairs FY 2018 – 2024 strategic plan. https://www.va.gov/oei/docs/VA2018-2024strategicPlan.pdf. Updated May 31, 2019. Accessed September 10, 2019.

Nearly 2.7 million veterans who rely on the Veterans Health Administration (VHA) for their health care live in rural communities.¹ Of these, more than half are aged ≥ 65 years. Rural veterans have greater rates of service-related disability and chronic medical conditions than do their urban counterparts.^1,2 Yet because of their rural location, they face unique challenges, including long travel times and distances to health care services, lack of public transportation options, and limited availability of specialized medical and social support services.

Compounding these geographic barriers is a more general lack of workforce infrastructure and a dearth of clinical health care providers (HCPs) skilled in geriatric medicine. The demand for geriatricians is projected to outpace supply and result in a national shortage of nearly 27 000 geriatricians by 2025.³ Moreover, the overwhelming majority (90%) of HCPs identifying as geriatric specialists reside in urban areas.⁴ This creates tremendous pressure on the health care system to provide remote care for older veterans contending with complex conditions, and ultimately these veterans may not receive the specialized care they need.

Telehealth modalities bridge these gaps by bringing health care to veterans in rural communities. They may also hold promise for strengthening community care in rural areas through workforce development and dissemination of educational resources. The VHA has been recognized as a leader in the field of telehealth since it began offering telehealth services to veterans in 1977^5-8 and served more than 677 000 Veterans via telehealth in fiscal year (FY) 2015.⁹ The VHA currently employs multiple modes of telehealth to increase veterans’ access to health care, including: (1) synchronous technology like clinical video telehealth (CVT), which provides live encounters between HCPs and patients using videoconferencing software; and (2) asynchronous technology, such as store-and-forward communication that offers remote transmission and clinical interpretation of veteran health data. The VHA has also strengthened its broad telehealth infrastructure by staffing VHA clinical sites with telehealth clinical technicians and providing telehealth hardware throughout.

The Department of Veterans Affairs (VA) Office of Geriatrics and Extended Care (GEC) and Office of Rural Health (ORH) established the Geriatric Research Education and Clinical Centers (GRECC) Connect project in 2014 to leverage the existing telehealth technologies at the VA to meet the health care needs of older veterans. GRECC Connect builds on the VHA network of geriatrics expertise in GRECCs by providing telehealth-based consultative support for rural primary care provider (PCP) teams, older veterans, and their families. This program profile describes this project’s mission, structure, and activities.

Program Overview

GRECC Connect leverages the clinical expertise and administrative infrastructure of participating GRECCs in order to reach clinicians and veterans in primarily rural communities.¹⁰ GRECCs are VA centers of excellence focused on aging and comprise a large network of interdisciplinary geriatrics expertise. All GRECCs have strong affiliations with local universities and are located in urban VA medical centers (VAMCs). GRECC Connect is based on a hub-and-spoke model in which urban GRECC hub sites are connected to community-based outpatient clinic (CBOC) and VAMC spokes that primarily serve veterans in other communities. CBOCs are stand-alone clinics that are geographically separate from a related VA medical center and provide outpatient primary care, mental health care services, and some specialty care services such as cardiology or neurology. They range in size from small, mainly telehealth clinics with 1 technician to large clinics with several specialty providers. Each GRECC hub site partners with an average of 6 CBOCs (range 3-16), each of which is an average distance of 92.8 miles from the related VA medical center (range 20-406 miles).