PDF(Pubmed)
Abstract：
UNASSIGNED: During the COVID-19 pandemic, the Veterans Health Administration (VHA) expanded telehealth infrastructure. Understanding telehealth initiation and sustained engagement could inform future resource allocation for high-need populations.
UNASSIGNED: To describe and examine primary care use, including initiation, use, and engagement factors, of telehealth modalities (telephone, video visits, and secure messaging) from 2020 to 2022.
UNASSIGNED: This cohort study was conducted among 1 383 070 patients in the 75th or higher percentile for 90-day risk of hospitalization or mortality (using previously validated Care Assessment Need scores) engaged in VHA primary care from March 11, 2019, to March 10, 2022.
UNASSIGNED: Patient sociodemographic characteristics (age, sex, race and ethnicity, and marital and housing status), health characteristics (chronic condition count, military service disability, serious mental illness, or substance use disorder diagnoses), geographic characteristics (driving distance to clinic and rural or urban location), and Federal Communications Commission-reported broadband speed among subgroups of patients at high risk categorized by telehealth use from 2020 to 2022.
UNASSIGNED: Primary care utilization by modality.
UNASSIGNED: A total of 1 383 070 patients at high risk were engaged in VHA primary care in March 2020 (median age, 73.0 years [IQR, 65-80 years]; 92.4% male; 77.7% regular telehealth users in 2019). With the onset of the COVID-19 pandemic from March 2020 to March 2021, 92.7% of patients at high risk (1 158 804 of 1 250 438 retained in care) became regular telehealth users. The following year, most patients continued as telehealth users (83.4% [942 151 of 1 129 683 retained]), including 38.2% retention of users at high risk newly engaged in 2020. Between 2019 and 2022 among those living and engaged in VHA primary care, adjusted exploratory multinomial logit models estimated that new telehealth users in 2020 (both sustained or only transiently engaged) were more often Black non-Hispanic individuals with greater comorbidity burdens than those who never engaged in telehealth use (Black non-Hispanic with new persistent telehealth use: adjusted relative risk ratio [ARR], 1.18 [95% CI, 1.16-1.20]; Black non-Hispanic with transient telehealth use: ARR, 1.11 [95% CI, 1.08-1.13]; ≥5 chronic conditions with new persistent telehealth use: ARR, 1.92 [95% CI, 1.88-1.96]; ≥5 chronic conditions with transient telehealth use: ARR, 1.43 [95% CI, 1.40-1.46]).
UNASSIGNED: This cohort study suggests that primary care telehealth initiation, use and sustained engagement differed among subgroups of patients at high risk throughout the COVID-19 pandemic. Those never or only transiently engaged with telehealth had lower illness burdens and were less likely to identify as members of racial or ethnic minority groups. Variation in telehealth use among subgroups of patients at high risk during this period could inform future resource allocation.
UNASSIGNED: To describe and examine primary care use, including initiation, use, and engagement factors, of telehealth modalities (telephone, video visits, and secure messaging) from 2020 to 2022.
UNASSIGNED: This cohort study was conducted among 1 383 070 patients in the 75th or higher percentile for 90-day risk of hospitalization or mortality (using previously validated Care Assessment Need scores) engaged in VHA primary care from March 11, 2019, to March 10, 2022.
UNASSIGNED: Patient sociodemographic characteristics (age, sex, race and ethnicity, and marital and housing status), health characteristics (chronic condition count, military service disability, serious mental illness, or substance use disorder diagnoses), geographic characteristics (driving distance to clinic and rural or urban location), and Federal Communications Commission-reported broadband speed among subgroups of patients at high risk categorized by telehealth use from 2020 to 2022.
UNASSIGNED: Primary care utilization by modality.
UNASSIGNED: A total of 1 383 070 patients at high risk were engaged in VHA primary care in March 2020 (median age, 73.0 years [IQR, 65-80 years]; 92.4% male; 77.7% regular telehealth users in 2019). With the onset of the COVID-19 pandemic from March 2020 to March 2021, 92.7% of patients at high risk (1 158 804 of 1 250 438 retained in care) became regular telehealth users. The following year, most patients continued as telehealth users (83.4% [942 151 of 1 129 683 retained]), including 38.2% retention of users at high risk newly engaged in 2020. Between 2019 and 2022 among those living and engaged in VHA primary care, adjusted exploratory multinomial logit models estimated that new telehealth users in 2020 (both sustained or only transiently engaged) were more often Black non-Hispanic individuals with greater comorbidity burdens than those who never engaged in telehealth use (Black non-Hispanic with new persistent telehealth use: adjusted relative risk ratio [ARR], 1.18 [95% CI, 1.16-1.20]; Black non-Hispanic with transient telehealth use: ARR, 1.11 [95% CI, 1.08-1.13]; ≥5 chronic conditions with new persistent telehealth use: ARR, 1.92 [95% CI, 1.88-1.96]; ≥5 chronic conditions with transient telehealth use: ARR, 1.43 [95% CI, 1.40-1.46]).
UNASSIGNED: This cohort study suggests that primary care telehealth initiation, use and sustained engagement differed among subgroups of patients at high risk throughout the COVID-19 pandemic. Those never or only transiently engaged with telehealth had lower illness burdens and were less likely to identify as members of racial or ethnic minority groups. Variation in telehealth use among subgroups of patients at high risk during this period could inform future resource allocation.
摘要：
■在COVID-19大流行期间，退伍军人健康管理局（VHA）扩大了远程医疗基础设施。了解远程保健的启动和持续参与可以为未来高需求人群的资源分配提供信息。
■为了描述和检查初级保健的使用，包括启动,使用,和参与因素，远程医疗模式(电话，视频访问,和安全消息）从2020年到2022年。
■这项队列研究是在2019年3月11日至2022年3月10日从事VHA初级护理的第90天住院或死亡风险（使用先前验证的护理评估需求评分）的第75百分位或更高百分位数的1383070名患者中进行的。
■患者社会人口统计学特征（年龄，性别,种族和民族,以及婚姻和住房状况)，健康特征(慢性病计数，兵役残疾,严重的精神疾病,或物质使用障碍诊断)，地理特征（到诊所的行驶距离以及农村或城市位置），联邦通信委员会报告了2020年至2022年按远程医疗使用分类的高风险患者亚组的宽带速度。
■按方式划分的初级保健利用率。
■2020年3月，共有1383070名高风险患者接受了VHA初级保健（中位年龄，73.0年[IQR，65-80岁]；92.4%的男性；2019年77.7%的常规远程医疗用户）。随着2020年3月至2021年3月COVID-19大流行的爆发，92.7%的高风险患者(1,158,804/1,250438保留在护理中)成为定期远程医疗使用者。第二年,大多数患者继续作为远程医疗用户(83.4%[942151/1129683保留])，包括在2020年新参与的高风险用户的38.2%的保留率。从2019年到2022年，在生活和从事VHA初级保健的人中，调整后的探索性多项Logit模型估计，2020年新的远程医疗用户(持续或仅短暂参与)比从未参与远程医疗使用的非西班牙裔黑人更多，其合并症负担更大(具有新的持续远程医疗使用的非西班牙裔黑人:调整后的相对风险比[ARR]，1.18[95%CI，1.16-1.20]；短暂使用远程医疗的黑人非西班牙裔：ARR，1.11[95%CI，1.08-1.13]；≥5种慢性疾病，伴有新的持续远程医疗使用：ARR，1.92[95%CI，1.88-1.96]；≥5例短暂使用远程医疗的慢性疾病：ARR，1.43[95%CI，1.40-1.46]）。
■这项队列研究表明，初级保健远程保健启动，在整个COVID-19大流行期间，高危患者亚组的使用和持续参与存在差异。那些从未或只是暂时参与远程医疗的人的疾病负担较低，不太可能被认定为种族或少数族裔群体的成员。在此期间，高危患者亚组之间远程医疗使用的变化可能会为未来的资源分配提供信息。
■为了描述和检查初级保健的使用，包括启动,使用,和参与因素，远程医疗模式(电话，视频访问,和安全消息）从2020年到2022年。
■这项队列研究是在2019年3月11日至2022年3月10日从事VHA初级护理的第90天住院或死亡风险（使用先前验证的护理评估需求评分）的第75百分位或更高百分位数的1383070名患者中进行的。
■患者社会人口统计学特征（年龄，性别,种族和民族,以及婚姻和住房状况)，健康特征(慢性病计数，兵役残疾,严重的精神疾病,或物质使用障碍诊断)，地理特征（到诊所的行驶距离以及农村或城市位置），联邦通信委员会报告了2020年至2022年按远程医疗使用分类的高风险患者亚组的宽带速度。
■按方式划分的初级保健利用率。
■2020年3月，共有1383070名高风险患者接受了VHA初级保健（中位年龄，73.0年[IQR，65-80岁]；92.4%的男性；2019年77.7%的常规远程医疗用户）。随着2020年3月至2021年3月COVID-19大流行的爆发，92.7%的高风险患者(1,158,804/1,250438保留在护理中)成为定期远程医疗使用者。第二年,大多数患者继续作为远程医疗用户(83.4%[942151/1129683保留])，包括在2020年新参与的高风险用户的38.2%的保留率。从2019年到2022年，在生活和从事VHA初级保健的人中，调整后的探索性多项Logit模型估计，2020年新的远程医疗用户(持续或仅短暂参与)比从未参与远程医疗使用的非西班牙裔黑人更多，其合并症负担更大(具有新的持续远程医疗使用的非西班牙裔黑人:调整后的相对风险比[ARR]，1.18[95%CI，1.16-1.20]；短暂使用远程医疗的黑人非西班牙裔：ARR，1.11[95%CI，1.08-1.13]；≥5种慢性疾病，伴有新的持续远程医疗使用：ARR，1.92[95%CI，1.88-1.96]；≥5例短暂使用远程医疗的慢性疾病：ARR，1.43[95%CI，1.40-1.46]）。
■这项队列研究表明，初级保健远程保健启动，在整个COVID-19大流行期间，高危患者亚组的使用和持续参与存在差异。那些从未或只是暂时参与远程医疗的人的疾病负担较低，不太可能被认定为种族或少数族裔群体的成员。在此期间，高危患者亚组之间远程医疗使用的变化可能会为未来的资源分配提供信息。
