JMIR Publications

ABSTRACT

Background:

Virtual care (care delivered by phone or video) comprises a substantial proportion of cardiology care delivered in the Veterans Health Administration (VHA). Little is known about how factors specific to patients, clinicians, and facilities contribute to variation in virtual cardiology utilization.

Objective:

Estimate the relative extent to which patient-, clinician-, and facility-level factors affect virtual cardiology care utilization in VHA.

Methods:

Design: Retrospective cohort study of cardiology virtual care utilization during the first two years of the COVID-19 pandemic (3/11/2020- 3/10/2022). Setting: VHA, nation-wide. Participants: Veterans who received cardiology care prior to and during the COVID-19 pandemic. Exposure: Modality of cardiology visits (telephone, video, or in-person). Main Outcome and Measures: We constructed multi-level multivariable logistic regression models of patient-level virtual care use. Models included random effects for the patient, the patient’s main cardiology provider, and the patient’s primary facility (i.e., VHA medical center) for specialty care, and fixed effects for patient sociodemographic and clinical characteristics.

Results:

Our analytic cohort comprised 223,809 Veterans with 989,271 encounters among 2,235 unique clinicians. Veterans’ average age was 70.2 years and 3% were women. 4% of encounters were video-based and 32% were phone-based. Adjusted odds of virtual care use were slightly higher for women vs men (adjusted odds ratio [AOR] 1.08 [95% confidence interval 1.05,1.10]), Hispanic/Latino vs not Hispanic/Latino, AOR 1.46 [1.43,1.49]; and those with medium and long drive times vs short drive time, AOR 1.11 and 1.09 respectively [1.10,1.12 and 1.07, 1.10]). 40% of the variation in a Veteran’s likelihood of using virtual care was found at the patient level, 31% at the clinician level, and 7% at the facility level.

Conclusions:

The largest share of the attributable variability in VHA cardiology virtual care utilization in this cohort was explained by the patient, followed closely by the clinician. Very little variability was attributed to the primary facility through which the Veteran received their cardiology care. These results suggest that policy solutions intended improve equity of virtual cardiology care use in VHA may be most impactful when directed at the patient and clinician levels. Clinical Trial: Not applicable