Virtual Care Expansion in the Veterans Health Administration During the COVID-19 Pandemic: Clinical Services and Patient Characteristics Associated with Utilization.
Identifieur interne : 000155 ( Main/Exploration ); précédent : 000154; suivant : 000156Virtual Care Expansion in the Veterans Health Administration During the COVID-19 Pandemic: Clinical Services and Patient Characteristics Associated with Utilization.
Auteurs : Jacqueline M. Ferguson [États-Unis] ; Josephine Jacobs [États-Unis] ; Maria Yefimova [États-Unis] ; Liberty Greene [États-Unis] ; Leonie Heyworth [États-Unis] ; Donna M. Zulman [États-Unis]Source :
- Journal of the American Medical Informatics Association : JAMIA [ 1527-974X ] ; 2020.
Abstract
OBJECTIVES
To describe the shift from in-person to virtual care within Veterans Affairs (VA) during the early phase of the COVID-19 pandemic, and to identify at-risk patient populations who require greater resources to overcome access barriers to virtual care.
MATERIALS AND METHODS
Outpatient encounters (N = 42,916,349) were categorized by care type (e.g. primary, mental health, etc.) and delivery method (e.g., in-person, video). For 5,400,878 Veterans, we used Generalized Linear models to identify patient sociodemographic and clinical characteristics associated with: 1) use of virtual (phone or video) care versus no virtual care and 2) use of video care versus no video care; between 3/11/2020 and 6/6/2020.
RESULTS
By June, 58% of VA care was provided virtually compared to only 14% prior. Patients with lower income, higher disability, and more chronic conditions were more likely to receive virtual care during the pandemic. Yet, Veterans aged 45-64 and 65+ were less likely to use video care compared to those aged 18-44 (aRR 0.80 [95%CI 0.79, 0.82] and 0.50 [0.48, 0.52], respectively). Rural and homeless Veterans were 12% and 11% less likely to use video care compared to urban (0.88 [0.86, 0.90]) and non-homeless Veterans (0.89 [0.86, 0.92]).
DISCUSSION
Veterans with high clinical or social need had higher likelihood of virtual service use early in the COVID-19 pandemic, however, older, homeless, and rural Veterans were less likely to have video visits, raising concerns for access barriers.
CONCLUSIONS AND RELEVANCE
While virtual care may expand access, access barriers must be addressed to avoid exacerbating disparities.
DOI: 10.1093/jamia/ocaa284
PubMed: 33125032
PubMed Central: PMC7665538
Affiliations:
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Ferguson</name><affiliation wicri:level="2"><nlm:affiliation>Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation><affiliation wicri:level="2"><nlm:affiliation>Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Jacobs, Josephine" sort="Jacobs, Josephine" uniqKey="Jacobs J" 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first="Liberty" last="Greene">Liberty Greene</name><affiliation wicri:level="2"><nlm:affiliation>Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation><affiliation wicri:level="2"><nlm:affiliation>Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Heyworth, Leonie" sort="Heyworth, Leonie" uniqKey="Heyworth L" first="Leonie" last="Heyworth">Leonie Heyworth</name><affiliation wicri:level="3"><nlm:affiliation>Office of Connected Care/Telehealth, Department of Veterans Affairs Central Office, Washington DC, United States.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Office of Connected Care/Telehealth, Department of Veterans Affairs Central Office, Washington DC</wicri:regionArea><placeName><settlement type="city">Washington (district de Columbia)</settlement><region type="state">District de Columbia</region></placeName></affiliation><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, University of California, San Diego School of Medicine, San Diego CA, United States.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, University of California, San Diego School of Medicine, San Diego CA</wicri:regionArea><wicri:noRegion>San Diego CA</wicri:noRegion></affiliation></author><author><name sortKey="Zulman, Donna M" sort="Zulman, Donna M" uniqKey="Zulman D" first="Donna M" last="Zulman">Donna M. Zulman</name><affiliation wicri:level="2"><nlm:affiliation>Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation><affiliation wicri:level="2"><nlm:affiliation>Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author></analytic><series><title level="j">Journal of the American Medical Informatics Association : JAMIA</title><idno type="eISSN">1527-974X</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVES</b></p><p>To describe the shift from in-person to virtual care within Veterans Affairs (VA) during the early phase of the COVID-19 pandemic, and to identify at-risk patient populations who require greater resources to overcome access barriers to virtual care.</p></div><div type="abstract" xml:lang="en"><p><b>MATERIALS AND METHODS</b></p><p>Outpatient encounters (N = 42,916,349) were categorized by care type (e.g. primary, mental health, etc.) and delivery method (e.g., in-person, video). For 5,400,878 Veterans, we used Generalized Linear models to identify patient sociodemographic and clinical characteristics associated with: 1) use of virtual (phone or video) care versus no virtual care and 2) use of video care versus no video care; between 3/11/2020 and 6/6/2020.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>By June, 58% of VA care was provided virtually compared to only 14% prior. Patients with lower income, higher disability, and more chronic conditions were more likely to receive virtual care during the pandemic. Yet, Veterans aged 45-64 and 65+ were less likely to use video care compared to those aged 18-44 (aRR 0.80 [95%CI 0.79, 0.82] and 0.50 [0.48, 0.52], respectively). Rural and homeless Veterans were 12% and 11% less likely to use video care compared to urban (0.88 [0.86, 0.90]) and non-homeless Veterans (0.89 [0.86, 0.92]).</p></div><div type="abstract" xml:lang="en"><p><b>DISCUSSION</b></p><p>Veterans with high clinical or social need had higher likelihood of virtual service use early in the COVID-19 pandemic, however, older, homeless, and rural Veterans were less likely to have video visits, raising concerns for access barriers.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS AND RELEVANCE</b></p><p>While virtual care may expand access, access barriers must be addressed to avoid exacerbating disparities.</p></div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">33125032</PMID><DateRevised><Year>2020</Year><Month>11</Month><Day>17</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1527-974X</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2020</Year><Month>Oct</Month><Day>30</Day></PubDate></JournalIssue><Title>Journal of the American Medical Informatics Association : JAMIA</Title><ISOAbbreviation>J Am Med Inform Assoc</ISOAbbreviation></Journal><ArticleTitle>Virtual Care Expansion in the Veterans Health Administration During the COVID-19 Pandemic: Clinical Services and Patient Characteristics Associated with Utilization.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">ocaa284</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1093/jamia/ocaa284</ELocationID><Abstract><AbstractText Label="OBJECTIVES" NlmCategory="OBJECTIVE">To describe the shift from in-person to virtual care within Veterans Affairs (VA) during the early phase of the COVID-19 pandemic, and to identify at-risk patient populations who require greater resources to overcome access barriers to virtual care.</AbstractText><AbstractText Label="MATERIALS AND METHODS" NlmCategory="METHODS">Outpatient encounters (N = 42,916,349) were categorized by care type (e.g. primary, mental health, etc.) and delivery method (e.g., in-person, video). For 5,400,878 Veterans, we used Generalized Linear models to identify patient sociodemographic and clinical characteristics associated with: 1) use of virtual (phone or video) care versus no virtual care and 2) use of video care versus no video care; between 3/11/2020 and 6/6/2020.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">By June, 58% of VA care was provided virtually compared to only 14% prior. Patients with lower income, higher disability, and more chronic conditions were more likely to receive virtual care during the pandemic. Yet, Veterans aged 45-64 and 65+ were less likely to use video care compared to those aged 18-44 (aRR 0.80 [95%CI 0.79, 0.82] and 0.50 [0.48, 0.52], respectively). Rural and homeless Veterans were 12% and 11% less likely to use video care compared to urban (0.88 [0.86, 0.90]) and non-homeless Veterans (0.89 [0.86, 0.92]).</AbstractText><AbstractText Label="DISCUSSION" NlmCategory="CONCLUSIONS">Veterans with high clinical or social need had higher likelihood of virtual service use early in the COVID-19 pandemic, however, older, homeless, and rural Veterans were less likely to have video visits, raising concerns for access barriers.</AbstractText><AbstractText Label="CONCLUSIONS AND RELEVANCE" NlmCategory="CONCLUSIONS">While virtual care may expand access, access barriers must be addressed to avoid exacerbating disparities.</AbstractText><CopyrightInformation>Published by Oxford University Press on behalf of the American Medical Informatics Association 2020. This work is written by US Government employees and is in the public domain in the US.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Ferguson</LastName><ForeName>Jacqueline M</ForeName><Initials>JM</Initials><AffiliationInfo><Affiliation>Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jacobs</LastName><ForeName>Josephine</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yefimova</LastName><ForeName>Maria</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Office of Research Patient Care Services, Stanford Health Care, Stanford CA, United States.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Greene</LastName><ForeName>Liberty</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Heyworth</LastName><ForeName>Leonie</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Office of Connected Care/Telehealth, Department of Veterans Affairs Central Office, Washington DC, United States.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Medicine, University of California, San Diego School of Medicine, San Diego CA, United States.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zulman</LastName><ForeName>Donna M</ForeName><Initials>DM</Initials><AffiliationInfo><Affiliation>Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>10</Month><Day>30</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>J Am Med Inform Assoc</MedlineTA><NlmUniqueID>9430800</NlmUniqueID><ISSNLinking>1067-5027</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">Veterans</Keyword><Keyword MajorTopicYN="N">access to care</Keyword><Keyword MajorTopicYN="N">disparities</Keyword><Keyword MajorTopicYN="N">telemedicine</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>09</Month><Day>22</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2020</Year><Month>10</Month><Day>16</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>10</Month><Day>19</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>10</Month><Day>30</Day><Hour>12</Hour><Minute>9</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>10</Month><Day>31</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>10</Month><Day>31</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>aheadofprint</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33125032</ArticleId><ArticleId IdType="pii">5943879</ArticleId><ArticleId IdType="doi">10.1093/jamia/ocaa284</ArticleId><ArticleId IdType="pmc">PMC7665538</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>États-Unis</li></country><region><li>Californie</li><li>District de 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Ferguson</name></region><name sortKey="Ferguson, Jacqueline M" sort="Ferguson, Jacqueline M" uniqKey="Ferguson J" first="Jacqueline M" last="Ferguson">Jacqueline M. Ferguson</name><name sortKey="Greene, Liberty" sort="Greene, Liberty" uniqKey="Greene L" first="Liberty" last="Greene">Liberty Greene</name><name sortKey="Greene, Liberty" sort="Greene, Liberty" uniqKey="Greene L" first="Liberty" last="Greene">Liberty Greene</name><name sortKey="Heyworth, Leonie" sort="Heyworth, Leonie" uniqKey="Heyworth L" first="Leonie" last="Heyworth">Leonie Heyworth</name><name sortKey="Heyworth, Leonie" sort="Heyworth, Leonie" uniqKey="Heyworth L" first="Leonie" last="Heyworth">Leonie Heyworth</name><name sortKey="Jacobs, Josephine" sort="Jacobs, Josephine" uniqKey="Jacobs J" first="Josephine" last="Jacobs">Josephine Jacobs</name><name sortKey="Yefimova, Maria" sort="Yefimova, Maria" uniqKey="Yefimova M" first="Maria" last="Yefimova">Maria Yefimova</name><name sortKey="Yefimova, Maria" sort="Yefimova, Maria" uniqKey="Yefimova M" first="Maria" last="Yefimova">Maria Yefimova</name><name sortKey="Yefimova, Maria" sort="Yefimova, Maria" uniqKey="Yefimova M" first="Maria" last="Yefimova">Maria Yefimova</name><name sortKey="Zulman, Donna M" sort="Zulman, Donna M" uniqKey="Zulman D" first="Donna M" last="Zulman">Donna M. Zulman</name><name sortKey="Zulman, Donna M" sort="Zulman, Donna M" uniqKey="Zulman D" first="Donna M" last="Zulman">Donna M. Zulman</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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