背景:视频远程医疗提供了一种机制来帮助退伍军人健康管理局(VHA)患者克服医疗保健障碍;然而,许多退伍军人缺乏合适的设备和足够的互联网连接。为了解决技术获取方面的差距,VHA建立了连接设备计划,该计划为退伍军人提供了具有视频功能的平板电脑和互联网服务。2020年,VHA引入了国家数字鸿沟咨询,以促进和标准化该资源的推荐。
目标:我们试图评估VHA的连接设备计划的范围和影响,利用数字鸿沟咨询数据,以确定资源是否支持退伍军人的医疗保健需求和访问障碍。
方法:我们使用来自VHA电子健康记录的国家二级数据,对119,926名接受平板电脑的患者(2020年4月1日至2023年2月28日)和来自一般VHA人群的683,219名退伍军人进行了检查。我们评估了与一般VHA人群相比,实施DigitalDivideConsult前后片剂接受者的人口统计学和临床特征的变化。我们检查了平板电脑的影响和对采用远程医疗的咨询(即,视频访问使用和访问次数)调整平板电脑接受者和一般VHA人群之间的差异。最后,我们通过根据平板电脑转诊原因评估视频服务的使用情况来评估咨询实施情况.
结果:转诊的常见原因包括心理健康诊断(50,367/79,230,63.9%),与VHA设施的距离>30英里(17,228/79,230,21.7%),和社会隔离(16161/79230,20.4%)。此外,63.0%(49,925/79,230)在实施DigitalDivideConsult后收到平板电脑的个人在收到平板电脑的前6个月内进行了视频访问。一些咨询原因与视频远程医疗使用比例高于平均水平有关,包括参加基于证据的心理健康计划(74.8%[830/1100]使用视频),居住在距离VHA设施超过30英里的地方(68.3%[10,557/17,228]有视频使用),并进行了心理健康诊断(使用视频的68.1%[34,301/50,367])。与一般的VHA人群相比,一旦提供平板电脑,平板电脑接受者在一个月内进行视频访问的可能性几乎是其3倍。咨询实施前调整后风险比为2.95(95%CI2.91-2.99),咨询实施后调整后风险比为2.73(95%CI2.70-2.76)。对远程医疗采用的分析表明,接受平板电脑进行精神保健和循证计划的退伍军人的视频访问率更高,而那些在家或接受临终关怀药片的人不使用的比例更高。
结论:对VHA的连接设备计划的评估表明,平板电脑正在促进具有复杂需求的退伍军人的基于视频的护理。通过数字鸿沟咨询进行的推荐标准化创造了机会,可以识别远程医疗采用率较低的平板电脑接受者群体,他们可能会从有针对性的干预中受益。
BACKGROUND: Video telehealth offers a mechanism to help Veterans Health Administration (VHA) patients overcome health care access barriers; however, many veterans lack a suitable device and sufficient internet connectivity. To address disparities in technology access, VHA established a Connected Device Program that offers veterans loaned video-capable tablets and internet service. In 2020, VHA introduced a national Digital Divide Consult to facilitate and standardize referrals for this resource.
OBJECTIVE: We sought to evaluate the reach and impact of VHA\'s Connected Device Program, leveraging Digital Divide Consult data to determine whether resources are supporting veterans with health care needs and access barriers.
METHODS: We examined the reach of VHA\'s Connected Device Program using national secondary data from VHA\'s electronic health records among 119,926 tablet recipients who received a tablet (April 1, 2020, to February 28, 2023) and 683,219 veterans from the general VHA population. We assessed changes in tablet recipients\' demographic and clinical characteristics before and after implementation of the Digital Divide Consult compared with the general VHA population. We examined the impact of tablets and the consult on adoption of telehealth (ie, video visit use and number of visits) adjusting for differences between tablet recipients and the general VHA population. Finally, we evaluated consult implementation by assessing the use of video-based services by tablet referral reason.
RESULTS: Common reasons for tablet referral included mental health diagnoses (50,367/79,230, 63.9%), distance from a VHA facility >30 miles (17,228/79,230, 21.7%), and social isolation (16,161/79,230, 20.4%). Moreover, 63.0% (49,925/79,230) of individuals who received a tablet after implementation of the Digital Divide Consult had a video visit in the first 6 months of tablet receipt. Some consult reasons were associated with a higher-than-average percentage of video telehealth use, including enrollment in evidence-based mental health programs (74.8% [830/1100] with video use), living >30 miles from a VHA facility (68.3% [10,557/17,228] with video use), and having a mental health diagnosis (68.1% [34,301/50,367] with video use). Tablet recipients had nearly 3 times the likelihood of having a video visit within a month once provided a tablet compared to the general VHA population, with an adjusted risk ratio of 2.95 (95% CI 2.91-2.99) before consult implementation and 2.73 (95% CI 2.70-2.76) after consult implementation. Analyses of telehealth adoption suggested that veterans receiving tablets for mental health care and evidence-based programs have higher rates of video visits, while those who are homebound or receiving tablets for hospice have higher rates of nonuse.
CONCLUSIONS: This evaluation of VHA\'s Connected Device Program suggests that tablets are facilitating video-based care among veterans with complex needs. Standardization of referrals through the Digital Divide Consult has created opportunities to identify groups of tablet recipients with lower telehealth adoption rates who might benefit from a targeted intervention.