Navid Dardashti, Jacqueline M Ferguson, Andrew Nicholson, Leonie Heyworth, Timothy P Hogan, Nicholas McMahon, Cindie Slightam, Donna M Zulman, Scott E Sherman
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引用次数: 0
Abstract
Background: The VHA is the largest healthcare system in the US and an early adopter of telehealth. Barriers to adoption may exist among subpopulations of VHA patients.
Objective: To identify patterns in use of telehealth by modality, race, rurality, age and priority group before and during the COVID-19 pandemic.
Design: We used data from the VHA Pyramid Analytics database to determine quarterly telehealth utilization rates from October 2015 to March 2023 using a pre-post analysis. Main measures were stratified by race, rurality, age group, and VA priority groups.
Participants: Unique patients who used any VHA care within each Fiscal Year of the study period.
Interventions: N/A.
Main measures: Quarterly encounters by modality and number of users with one or more Provider to Home (PTH) encounters per 1000 unique patients.
Key results: There were 36,315,299 telehealth encounters completed by 4,597,055 users during the analytic period. From October 2015-March 2020, PTH video encounters grew from 3.2% of VHA telehealth encounters to 38%. From April 2020-March 2023, PTH video encounters accounted for 90.7% of VHA telehealth encounters. Uptake of PTH during the pandemic differed significantly between demographic groups. Quarterly users per 1000 unique patients (increase relative to reference group; p-values < 0.01) increased significantly more for urban-residing patients (44.9 relative to rural); Black, Asian, or Multi-Racial patients (Black: 52.1; Asian: 48.2; multi-racial: 57.5 relative to White), younger Veterans (age < 45: 113.0; age 45-64: 80.3 relative to age ≥ 65); and Veterans with major disabilities (127.3 relative to Veterans without special considerations).
Conclusions: With the expansion of PTH telehealth during the pandemic, there was a shift in sociodemographic patterns among patients receiving at-home video-based care. Moving forward, VA may choose to test implementation strategies that target different demographic groups to support equitable access to PTH care.
Supplementary information: The online version contains supplementary material available at 10.1007/s44250-025-00256-0.
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