JMIR Publications

ABSTRACT

Background:

Many Veterans experience barriers that impede their use of Veterans Health Administration (VHA) clinical and social services, including geographic and transportation difficulties, physical and mental health challenges, and socioeconomic stressors. Video telehealth (i.e., delivery of clinical care via video visits) offers one mechanism to overcome health care access barriers. However, video telehealth requires that patients have a suitable device and internet connectivity. In 2020, VHA implemented a national standardized consult called the Digital Divide Consult to target Veterans with recent and relevant health care needs, to receive VHA loaned video capable devices.

Objective:

In this work, we evaluate whether VHA provided video-enabled tablets are reaching and supporting Veterans with recent and relevant health care needs who might benefit from telehealth to overcome access barriers.

Methods:

In a QUERI Partnered Evaluation Initiative, we examined the reach of VHA’s tablet initiative using national, secondary data from VHA's electronic health records. This included changes in tablet recipients’ demographic and clinical characteristics pre- and post-implementation of the Digital Divide Consult. We examined the impact of tablets and the Digital Divide Consult on adoption of telehealth (i.e., video visit use and number of visits). We evaluated consult implementation by assessing use of video-based services by tablet referral reason. We included 119,926 tablet recipients who received a tablet between 4/1/2020-2/28/2023 and 683,219 nonrecipients.

Results:

Common reasons for tablet referral included mental health diagnoses (63.9%), distance from VHA >30 miles (21.7%), and social isolation (20.4%). On average, 63% 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 proportion of tablet recipients using video telehealth, including enrollment in evidence-based mental health program (74.8% with any video use), living more than 30 miles away from a VHA (68.3% with any video use), and having a mental health diagnosis (68.1% with any video use). Tablet recipients had nearly three times the likelihood of having a video visit within a month once provided a tablet compared to nonrecipients, 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 suggest Veterans receiving tablets for mental health care and specialized evidence-based programs have higher rates of video visits, while those who are homebound or receiving tablets for hospice have higher rates of non-use.

Conclusions:

This QUERI partnered-evaluation illustrates how VHA’s tablet initiative is facilitating video-based care among Veterans with complex needs. Standardization of referrals through the Digital Divide Consult created opportunities to identify groups of tablet recipients with lower telehealth adoption rates who might benefit from targeted intervention.