Bridging Gaps in Acute Care Access for Rural Veterans: The Reach and Impact of VA's Virtual Emergency and Urgent Care Programs

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health Pub Date : 2026-08-08 DOI:10.1111/jrh.70197

Anita A. Vashi, Linda Diem Tran, Tracy Urech, Allison Engstrom Buggaveeti, Liam Rose

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引用次数: 0

Abstract

Purpose

To evaluate the impact of the Veterans Health Administration's (VA) virtual acute care programs—tele-emergency care (TEC) and virtual care visits (VCV)—on short-term utilization, mortality, and costs among rural veterans.

Methods

This retrospective study used national call center data (January 2022–September 2024) linked with VA administrative and community care records. Completed TEC or VCV encounters were grouped by triage acuity: acute (recommended follow-up within 8 h; n = 61,408) and non-acute (>8 h; n = 66,319), and compared with matched controls using propensity-score methods. Primary outcomes were emergency department (ED) visits, hospital admissions, and 30-day mortality. Secondary outcomes included total, inpatient, outpatient, pharmacy, and community care costs.

Findings

Among 631,437 nurse triage calls from rural veterans, virtual care was associated with significantly lower ED visits (acute: −11.87 percentage points (pp), 95% CI −12.47 to −11.26; non-acute: −3.62 pp, 95% CI −4.02 to −3.22) and hospitalizations (acute: −0.55 pp; non-acute: −0.15 pp). Thirty-day mortality did not differ significantly in either group. Total costs were modestly higher in both groups that received virtual care (acute: +$549; non-acute: +$386), driven by outpatient spending and partially offset by lower community care costs.

Conclusions

Virtual acute care substantially reduced short-term emergency and hospital utilization among rural veterans across both acuity groups but was associated with higher total 30-day costs. These findings highlight the potential of embedded virtual programs to improve access for rural veterans, while underscoring the need to evaluate their long-term value and return on investment.

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弥合农村退伍军人获得急症护理的差距：退伍军人事务部虚拟急诊和紧急护理计划的范围和影响。

目的：评估退伍军人健康管理局（VA）的虚拟急症护理项目——远程急救护理（TEC）和虚拟护理访问（VCV）对农村退伍军人短期利用、死亡率和成本的影响。方法：本回顾性研究使用国家呼叫中心数据（2022年1月至2024年9月）与VA行政和社区护理记录相关联。完成的TEC或VCV遭遇按分类急性程度分组：急性（建议在8小时内随访；n = 61,408）和非急性（>8小时；n = 66,319），并使用倾向评分方法与匹配对照进行比较。主要结局为急诊科（ED）访问量、住院率和30天死亡率。次要结局包括总费用、住院费用、门诊费用、药房费用和社区护理费用。研究结果：在631,437个来自农村退伍军人的护士分诊电话中，虚拟护理与急诊科就诊显著降低相关(急性：-11.87个百分点（pp）， 95% CI -12.47至-11.26；非急性：-3.62 pp, 95% CI -4.02至-3.22)和住院（急性：-0.55 pp；非急性：-0.15 pp）。两组的30天死亡率均无显著差异。接受虚拟护理的两组的总成本略高（急性：+ 549美元；非急性：+ 386美元），这是由门诊费用驱动的，部分被较低的社区护理费用抵消。结论：虚拟急症护理大大降低了农村退伍军人在两个急症组中的短期急诊和住院使用率，但与较高的30天总费用相关。这些发现突出了嵌入式虚拟项目在改善农村退伍军人获得服务方面的潜力，同时也强调了评估其长期价值和投资回报的必要性。

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来源期刊

Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

6.10%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.