Assessing Racial and Ethnic Disparities in Receipt of Tele-Emergency Care.

Abstract

Background: In 2021, the Veterans Health Administration (VA) initiated a Tele-Emergency Care (TEC) program, where care is provided through phone or video by an emergency medicine provider to Veterans with urgent, unscheduled medical concerns. Early data suggest TEC effectively resolves Veterans' care concerns and decreases low-value emergency department visits. Equity of TEC receipt has yet to be assessed.

Objective: To assess differences, by race and ethnicity, of Veterans' receipt of TEC.

Research design: Cross-sectional study.

Subjects: Veterans who used TEC and/or low-acuity in-person VA emergency care in Southern California, Arizona, and New Mexico, from March 1, 2021 to May 1, 2023.

Measures: TEC and/or low-acuity in-person VA care use.

Results: Veterans who only had TEC visits were less likely than those who only had in-person visits to be of racial and ethnic minority groups, namely Asian (1.38% vs. 3.54%, P<0.001), Black (12.2% vs. 18.1%, P<0.001), and Hispanic (15.7 vs. 19.1%, P<0.001). These findings persisted once adjusting for covariates; having only TEC visits was less likely than only having in-person care for Veterans who were Asian [relative risk (RR): 0.47, P<0.001], Black (RR: 0.61, P<0.001) or Hispanic (RR: 0.87, P<0.001), compared with White Veterans.

Conclusions: Receipt of TEC, or both TEC and in-person care, rather than exclusively in-person care, is lower among Asian, Black, and Hispanic Veterans compared with White Veterans, independent of covariates. To promote equity, future work should determine and address root causes of disparities, including digital device access, triage processes, and Veteran experiences.