Study Design and Setting
MAY
We conducted a cluster randomized trial to determine the impact of medical scribes on provider productivity, wait times, and patient satisfaction in VHA. We compared the outcomes from the intervention sites with baseline (pre-intervention) data (January–December 2019) and pilot period data (June 2020–June 2022) from the comparison sites. The months in between (January–May 2020) were excluded as some sites had begun to hire in anticipation of the start of the pilot, which was delayed by the onset of the COVID-19 pandemic and also caused sizable disruptions in patterns of care. Section 507 of the MISSION Act specified that at least four VAMCs included in the pilot must be located in rural and urban areas, with at least two in underserved areas, which we identified using the highest quartile of cardiology and orthopedics wait times from January 2018 to June 2019. Furthermore, 30% of the medical scribes were to be employed in ED and 70% in specialty care clinics. The Office of Veterans Access to Care (OVAC), now known as the Office for Integrated Veteran Care (IVC), developed a list of 32 VAMCs interested in participating in the pilot. We stratified the VAMCs into the relevant subcategories based on the requirements of the law and randomly selected VAMCs within each group for assignment to the intervention, with the remaining VAMCs included as the comparison group (Table VA Medical Centers Included, by Randomization Status and Specialty