Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, IA, USA.
Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, Iowa City, IA, USA.
J Gen Intern Med. 2024 Nov;39(14):2771-2779. doi: 10.1007/s11606-024-08835-2. Epub 2024 Jun 12.
The Veterans Health Administration (VHA) implemented the Clinical Resource Hub (CRH) program to fill staffing gaps in primary care (PC) clinics via telemedicine and maintain veterans' healthcare access.
To evaluate PC wait times before and after CRH implementation.
Comparative interrupted time series analysis among a retrospective observational cohort of PC clinics who did and did not use CRH during pre-implementation (October 2018-September 2019) and post-implementation (October 2019-February 2020) periods.
Clinics completing ≥10 CRH visits per month for 2 consecutive months and propensity matched control clinics.
Two measures of patient access (i.e., established, and new patient wait times) and one measure of clinic capacity (i.e., third next available appointment) were assessed. Clinics using CRH were 1:1 propensity score matched across clinical and demographic characteristics. Comparative interrupted time series models used linear mixed effects regression with random clinic-level intercepts and triple interaction (i.e., CRH use, pre- vs. post-implementation, and time) for trend and point estimations.
PC clinics using CRH (N = 79) were matched to clinics not using CRH (N = 79). In the 12-month pre-implementation, third next available time increased in CRH clinics (0.16 days/month; 95% CI = [0.07, 0.25]), and decreased in the 5 months post-implementation (-0.58 days/month; 95% CI = [-0.90, -0.27]). Post-implementation third next available time also decreased in control clinics (-0.48 days/month; 95% CI = [-0.81, -0.17]). Comparative differences remained non-significant. There were no statistical differences in established or new patient wait times by CRH user status, CRH implementation, or over time.
In a national VHA telemedicine program developed to provide gap coverage for PC clinics, no wait time differences were observed between clinics using and not using CRH services. This hub-and-spoke telemedicine service is an effective model to provide gap coverage while maintaining access. Further investigation of quality and long-term access remains necessary.
退伍军人健康管理局（VHA）实施了临床资源中心（CRH）计划，通过远程医疗填补初级保健（PC）诊所的人员空缺，并维持退伍军人的医疗保健服务。
评估 CRH 实施前后 PC 的等待时间。
对实施前（2018 年 10 月至 2019 年 9 月）和实施后（2019 年 10 月至 2020 年 2 月）期间使用和未使用 CRH 的 PC 诊所进行回顾性观察队列的比较性中断时间序列分析。
每月完成≥10 次 CRH 就诊且连续 2 个月的诊所和倾向评分匹配的对照诊所。
评估了患者获得服务的两个衡量指标（即已建立和新患者的等待时间）和一个诊所能力衡量指标（即第三个可预约的下一个就诊时间）。使用 CRH 的诊所根据临床和人口统计学特征进行了 1:1 的倾向评分匹配。比较性中断时间序列模型采用线性混合效应回归，随机诊所水平截距和三重交互（即 CRH 使用、实施前后和时间）进行趋势和点估计。
使用 CRH 的 PC 诊所（N=79）与未使用 CRH 的诊所（N=79）进行了匹配。在 12 个月的实施前阶段，CRH 诊所的第三个可预约时间增加了 0.16 天/月（95%CI=[0.07，0.25]），而在实施后的 5 个月中减少了 0.58 天/月（95%CI=[0.90，-0.27]）。在对照组中，实施后第三个可预约时间也减少了 0.48 天/月（95%CI=[0.81，-0.17]）。比较差异仍无统计学意义。根据 CRH 用户状态、CRH 实施情况或随时间变化，在已建立和新患者的等待时间方面没有差异。这种枢纽辐射型远程医疗服务是提供间隙覆盖的有效模式，同时保持可及性。仍需要进一步调查质量和长期可及性。
