Enterprise-Wide Initiative (EWI) - Primary Care
SCOUTS (Supporting Community, Outpatient, Urgent care, and Telehealth Services)
Background
Each year, more than a million high-risk Veterans seek acute care. Many of these visits are related to functional decline, unmet health care needs, or social needs such as limited support at home. If these problems are not addressed, Veterans are more likely to be hospitalized, fall, lose independence, or move into long-term care facilities.
The Office of Rural Health (ORH) Enterprise-Wide Initiative (EWI) called SCOUTS focuses on older or medically complex Veterans who live in the community and are at high risk for decline, falls, or hospitalization. These Veterans recently had a visit to a VA or community Emergency Department (ED) or an emergency telehealth visit.
SCOUTS provides early follow-up in the home and through telehealth, with special attention to rural Veterans who may have difficulty traveling to VA facilities.
Goals and Objectives
SCOUTS is designed to support Veterans after acute care visits by:
- Helping older and medically complex Veterans live safely and independently at home.
- Reducing stress and burden on caregivers.
- Reducing preventable ED visits and hospital admissions and offering an alternative to in-person follow-up visits.
- Providing in-home screenings, connecting Veterans to needed services, and increasing use of telehealth technologies.
These goals help Veterans recover safely at home while still receiving timely, high-quality follow-up care.
Methodology
In SCOUTS, older or medically complex Veterans receive a post-acute home visit from an Intermediate Care Technician (ICT). During the visit, the ICT:
- Checks home safety and mobility and looks for fall risks.
- Screens for common problems such as pain, medication issues, nutrition concerns, or memory changes.
- Asks about social needs such as food, transportation, and caregiver support.
- Assesses caregiver involvement and support needs.
Veterans are identified for SCOUTS during an acute care encounter at VA or after a community ED visit. Veterans already enrolled in other home care programs or living in long-term care facilities are excluded to avoid duplicate services.
SCOUTS home visits usually take place within 72 hours of the acute care visit, and often sooner if the Veteran was first seen only by telehealth. ICTs can perform minor follow-up procedures such as suture removal and provide education on durable medical equipment, VA services, and community resources.
The ICT also serves as a telepresenter for an acute care or specialty provider, such as physical therapy. Through a video visit, the provider reassesses the Veteran’s condition, addresses new concerns, and develops a plan to respond to screening results and home safety issues.
After the home visit, Veterans receive at least one follow-up phone call to confirm they are connected to their primary care team, that needed equipment has arrived, that referrals were made, and that follow-up appointments are scheduled.
The SCOUTS care model is:
- Interdisciplinary – A core SCOUTS team collaborates with Veterans and caregivers. ICTs work with a SCOUTS physician medical director and team members from nursing, pharmacy, social work, prosthetics, and physical therapy.
- Accessible – ICTs identify challenges during rapid, in-home, telehealth-assisted visits and help start needed in-home supports.
- Coordinated – ICTs coordinate care with real-time and follow-up medical direction from a licensed independent practitioner, then share key information with the Veteran’s primary care team and other team members.
- Veteran-focused – ICTs are advanced unlicensed assistive personnel with intensive military medical training. Many are Veterans, which supports strong Veteran-to-Veteran trust and connection.
Impact on Rural Veteran Health
SCOUTS has been especially valuable for frail rural Veterans who may experience health decline with long travel to a VA medical center. By bringing care into the home, SCOUTS combines telehealth convenience with many benefits of an in-person visit.
Using tools such as virtual wound cameras and tablet-connected otoscopes and stethoscopes, SCOUTS helps Veterans receive thorough assessments and follow-up care without leaving home. This is important in rural areas where travel can be long, difficult, or unsafe.
SCOUTS began in six locations in 2020 and has grown to 12 sites, including three active and two implementing sites supported by ORH. As of January 2025, SCOUTS has served more than 3,000 patients, and about one-third are rural Veterans.
Reported benefits include:
- 93% of participants said SCOUTS increased their knowledge of VA services.
- 57% said the visit made them more likely to choose VA for care; 41% said it reinforced their choice of VA.
- 46% received at least one piece of durable medical equipment, such as a wheelchair, walker, or cane.
- Social needs were identified and addressed for 358 Veterans (for example, food insecurity or lack of transportation).
- SCOUTS participants had lower hospital use than other ED patients age 65 and older, including lower 3‑day ED return rates and lower admission rates at 3 days, 30 days, and 90 days.
SCOUTS has also supported Veterans during emergencies. For example, after Hurricane Helene affected the Asheville area in 2024, SCOUTS helped rural Veterans who could not leave home receive needed care and supplies.
Key Takeaways
SCOUTS gives older and medically complex Veterans a way to have acute care needs addressed at home, supported by a medically trained telepresenter (the ICT). This helps bridge the gap between ED or urgent care visits and safe recovery at home.
Emergency Medicine providers can feel more confident discharging Veterans or using Tele‑Emergency Care when they know SCOUTS will provide a home visit and follow-up assessment within a few days.
- Veterans and ICTs report high satisfaction with SCOUTS, which often allows Veterans to care for fellow Veterans.
- SCOUTS helps Veterans receive needed equipment and VA services through its interdisciplinary team.
- The program can be used in many acute and follow-up settings and strengthens existing telehealth capabilities.
Overall, SCOUTS helps Veterans stay safely at home, improves coordination between acute and primary care, and supports better outcomes for rural and high-risk Veterans.
Download the Printable PDF for Healthcare Providers and Researchers.
References
- McQuown CM, Snell KT, Abbate LM, Jetter EM, Blatnik JK, Ragsdale LC. Telehealth for geriatric post-emergency department visits to promote age-friendly care. Health Services Research. 2023;58(Suppl 1):16–25.
- SCOUTS (Supporting Community, Outpatient, Urgent care, and Telehealth Services). VA Diffusion Marketplace. Accessed January 17, 2025.
- Suzuki S. Nothing stops Asheville SCOUT from serving Veterans. VA News. December 4, 2024. Accessed January 17, 2025.
- Snell S. Care technician brings SCOUTS services to Veterans at home. VA News. September 22, 2023. Accessed January 17, 2025.
- Prototyping Acute Care Geriatrics – SCOUTS. VA Emergency Medicine Catalyst. November 2022.
Contact
- Colleen McQuown, MD, SCOUTS Medical Director, Office of Primary Care, Louis Stokes VA Medical Center, Cleveland, OH. VHA11PCPrimaryCareAction@va.gov
- Funding Acknowledgement: U.S. Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, NOMAD #PRFY-00582.
- Suggested Citation: McQuown, C. (2025). SCOUTS (Supporting Community, Outpatient, Urgent care, and Telehealth Services). Department of Veterans Affairs, Veterans Health Administration. Washington, DC: Office of Rural Health.
Rural Health - Navigation
- Office of Rural Health Home page:
https://www.ruralhealth.va.gov/index.asp - Enterprise-Wide Initiatives (EWI) page:
https://www.ruralhealth.va.gov/Enterprise-Wide-Initiatives-EWI.asp - Veterans Rural Health Resource Centers (VRHRC) page:
https://www.ruralhealth.va.gov/Veterans-Rural-Health-Resource-Center-VRHRC.asp
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