TY - JOUR
KW - Military Medicine
KW - telehealth
KW - Telemedicine
KW - Vulnerable Populations
AU - K. Gujral
AU - J . Y. Scott
AU - L. Ambady
AU - C. E. Dismuke-Greer
AU - J. Jacobs
AU - A. Chow
AU - A. Oh
AU - J. Yoon
A1 - 
AB - Background: The Veterans Health Administration (VHA) piloted an innovative video telehealth program called Virtual Integrated Multisite Patient Aligned Care Teams (V-IMPACT) in fiscal year (FY) 2014. V-IMPACT set up one regional "hub" site where primary care (PC) teams provided regular PC through telehealth services to patients in outlying "spoke" sites that experienced gaps in provider coverage. We evaluated associations between clinic-level adoption of V-IMPACT and patients' utilization and VHA's costs for primary, emergency, and inpatient care. Materials and Methods: This observational study used repeated cross-sections of 208,612 unique veteran patients assigned to a PC team in 22 V-IMPACT spoke sites from FY2013 to FY2018. V-IMPACT adoption in a spoke site was indicated if more than 1% of patients assigned to PC in a site used V-IMPACT services during the year. Association between V-IMPACT adoption and outcomes were assessed using mixed-effects models. Results: V-IMPACT adoption was associated with increased telehealth visits for PC (incidence rate ratio [IRR] = 2.42 [1.29 to 4.55]) and for primary care mental health integration (IRR = 7.25 [2.69 to 19.54]). V-IMPACT adoption was not associated with in-person visits, or with total visits (in-person plus video telehealth). V-IMPACT adoption was also not associated with acute hospital stays, emergency department visits, or VHA costs. Conclusions: Programs such as VHA's V-IMPACT can increase telehealth visits for PC, allowing successful transition across modalities and facilitating continuity of care without impacting total care. Programs should track substitution of in-person visits with telehealth visits and examine its effects on patients' health outcomes, satisfaction, and travel costs.
AD - Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA.; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA.; Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA.; Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA.; Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA.; Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA.; Division of Geriatrics, Department of Medicine, UCSF, San Francisco, California, USA.; San Francisco VA Health Care System, San Francisco, California, USA.; Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA.; Department of General Internal Medicine, UCSF School of Medicine, San Francisco, California, USA.
BT - Telemedicine journal and e-health : the official journal of the American Telemedicine Association
C5 - Financing & Sustainability; Healthcare Disparities; HIT & Telehealth
CP - 5
DO - 10.1089/tmj.2021.0284
IS - 5
JF - Telemedicine journal and e-health : the official journal of the American Telemedicine Association
LA - eng
M1 - Journal Article
N2 - Background: The Veterans Health Administration (VHA) piloted an innovative video telehealth program called Virtual Integrated Multisite Patient Aligned Care Teams (V-IMPACT) in fiscal year (FY) 2014. V-IMPACT set up one regional "hub" site where primary care (PC) teams provided regular PC through telehealth services to patients in outlying "spoke" sites that experienced gaps in provider coverage. We evaluated associations between clinic-level adoption of V-IMPACT and patients' utilization and VHA's costs for primary, emergency, and inpatient care. Materials and Methods: This observational study used repeated cross-sections of 208,612 unique veteran patients assigned to a PC team in 22 V-IMPACT spoke sites from FY2013 to FY2018. V-IMPACT adoption in a spoke site was indicated if more than 1% of patients assigned to PC in a site used V-IMPACT services during the year. Association between V-IMPACT adoption and outcomes were assessed using mixed-effects models. Results: V-IMPACT adoption was associated with increased telehealth visits for PC (incidence rate ratio [IRR] = 2.42 [1.29 to 4.55]) and for primary care mental health integration (IRR = 7.25 [2.69 to 19.54]). V-IMPACT adoption was not associated with in-person visits, or with total visits (in-person plus video telehealth). V-IMPACT adoption was also not associated with acute hospital stays, emergency department visits, or VHA costs. Conclusions: Programs such as VHA's V-IMPACT can increase telehealth visits for PC, allowing successful transition across modalities and facilitating continuity of care without impacting total care. Programs should track substitution of in-person visits with telehealth visits and examine its effects on patients' health outcomes, satisfaction, and travel costs.
PY - 2022
SN - 1556-3669; 1530-5627
SP - 643
EP - 653+
T1 - A Primary Care Telehealth Pilot Program to Improve Access: Associations with Patients' Health Care Utilization and Costs
T2 - Telemedicine journal and e-health : the official journal of the American Telemedicine Association
TI - A Primary Care Telehealth Pilot Program to Improve Access: Associations with Patients' Health Care Utilization and Costs
U1 - Financing & Sustainability; Healthcare Disparities; HIT & Telehealth
U2 - 34559017
U3 - 10.1089/tmj.2021.0284
VL - 28
VO - 1556-3669; 1530-5627
Y1 - 2022
Y2 - Sep 24
ER -