退伍军人中初级、心理健康和专科视频护理的初始使用和持续使用情况存在差异。
Variation in initial and continued use of primary, mental health, and specialty video care among Veterans.
机构信息
Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.
Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA.
出版信息
Health Serv Res. 2023 Apr;58(2):402-414. doi: 10.1111/1475-6773.14098. Epub 2022 Nov 24.
OBJECTIVE
To identify which Veteran populations are routinely accessing video-based care.
DATA SOURCES AND STUDY SETTING
National, secondary administrative data from electronic health records at the Veterans Health Administration (VHA), 2019-2021.
STUDY DESIGN
This retrospective cohort analysis identified patient characteristics associated with the odds of using any video care; and then, among those with a previous video visit, the annual rate of video care utilization. Video care use was reported overall and stratified into care type (e.g., primary, mental health, and specialty video care) between March 10, 2020 and February 28, 2021.
DATA COLLECTION
Veterans active in VA health care (>1 outpatient visit between March 11, 2019 and March 10, 2020) were included in this study.
PRINCIPAL FINDINGS
Among 5,389,129 Veterans in this evaluation, approximately 27.4% of Veterans had at least one video visit. We found differences in video care utilization by type of video care: 14.7% of Veterans had at least one primary care video visit, 10.6% a mental health video visit, and 5.9% a specialty care video visit. Veterans with a history of housing instability had a higher overall rate of video care driven by their higher usage of video for mental health care compared with Veterans in stable housing. American Indian/Alaska Native Veterans had reduced odds of video visits, yet similar rates of video care when compared to White Veterans. Low-income Veterans had lower odds of using primary video care yet slightly elevated rates of primary video care among those with at least one video visit when compared to Veterans enrolled at VA without special considerations.
CONCLUSIONS
Variation in video care utilization patterns by type of care identified Veteran populations that might require greater resources and support to initiate and sustain video care use. Our data support service specific outreach to homeless and American Indian/Alaska Native Veterans.
目的
确定哪些退伍军人经常使用基于视频的医疗服务。
数据来源和研究环境
退伍军人事务部（VA）电子健康记录中的全国性二级行政数据，2019-2021 年。
研究设计
这项回顾性队列分析确定了与使用任何视频医疗服务几率相关的患者特征；然后，在有之前视频就诊的患者中，确定视频医疗服务的年度使用率。2020 年 3 月 10 日至 2021 年 2 月 28 日期间，总体报告了视频医疗服务的使用情况，并按护理类型（例如，初级护理、心理健康和专科视频护理）进行了分层。
数据收集
在 VA 医疗保健中活跃的退伍军人（2019 年 3 月 11 日至 2020 年 3 月 10 日之间有超过 1 次门诊就诊）被纳入本研究。
主要发现
在这项评估中，约 27.4%的退伍军人至少有一次视频就诊。我们发现不同类型视频医疗服务的利用率存在差异：14.7%的退伍军人至少有一次初级保健视频就诊，10.6%有心理健康视频就诊，5.9%有专科保健视频就诊。与住房稳定的退伍军人相比，有住房不稳定史的退伍军人总体上视频医疗服务使用率更高，这主要是因为他们更多地使用视频进行心理健康护理。与白人退伍军人相比，美国印第安人/阿拉斯加原住民退伍军人接受视频就诊的可能性较小，但接受视频护理的比例相似。低收入退伍军人接受初级视频护理的可能性较低，但与没有特殊考虑因素而在 VA 注册的退伍军人相比，那些至少接受过一次视频就诊的退伍军人接受初级视频护理的比例略高。
结论
按护理类型划分的视频医疗服务利用模式的差异确定了可能需要更多资源和支持来启动和维持视频医疗服务使用的退伍军人群体。我们的数据支持针对无家可归和美国印第安人/阿拉斯加原住民退伍军人开展特定服务的外展活动。
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