Wheat Chelle L, Kath Sara E, Nelson Karin M, Curtis Idamay, Reddy Ashok
Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.
Primary Care Analytics Team, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA.
J Gen Intern Med. 2025 May 20. doi: 10.1007/s11606-025-09615-2.
The Veterans Health Administration (VHA) launched the Clinical Resource Hub (CRH) program to address primary care staffing deficits and improve access.
To determine if the quality of primary care at clinics that use CRH services was similar to that of clinics that did not. Secondarily, to examine this association for clinics that serve a high proportion of minority Veterans.
A quasi-experimental study using VHA administrative data from October 2017 through September 2021. We applied interrupted time series models to estimate changes in primary care quality measures associated with CRH utilization. Results are reported as percentages.
National cohort of 107 propensity-matched VHA clinics that did and did not use CRH primary care services INTERVENTION(S): CRH primary care services MAIN MEASURE(S): Chronic disease quality measures KEY RESULTS: For diabetes quality measures, we found similar results between CRH-utilizing clinics and their controls, including annual HbA1c screening (0.0% percentage difference (-1.0%, 1.0%), p = 0.640), poor HbA1c control (-1.0% (-1.0%, 0.0%), p=0.111), control of blood pressure for Veterans with diabetes (1.0% (-0.0%, 3.0%), p=0.095), statin therapy for Veterans with diabetes (1.0% (0.0%, 1.0%), p=0.003), statin adherence for Veterans with diabetes (0.0% (-1.0%, 0.0%), p=0.292), and nephropathy screening (1.0% (0.0%, 1.0%), p=0.010). There were no differences between clinic groups for control of blood pressure (1.0% (-1.0%, 2.0%), p=0.382). For cardiovascular quality measures, including statin therapy for Veterans with cardiovascular disease (0.0% (-1.0%, 2.0%), p=0.348), and statin adherence for Veterans with cardiovascular disease (-1.0% (-3.0%, 1.0%), p=0.467), we found no differences between clinic groups. Similar results were found among clinics that serve a high proportion of minority Veterans.
We found that quality measures at CRH-utilizing clinics are similar to matched comparator clinics. These findings demonstrate that telehealth interventions, like CRH, can improve access to primary health care in a variety of settings, without impacting the quality of primary care.
退伍军人健康管理局（VHA）启动了临床资源中心（CRH）项目，以解决基层医疗人员短缺问题并改善医疗服务可及性。
确定使用CRH服务的诊所的基层医疗质量是否与未使用该服务的诊所相似。其次，研究这一关联在为高比例少数族裔退伍军人服务的诊所中的情况。
一项准实验研究，使用2017年10月至2021年9月的VHA行政数据。我们应用中断时间序列模型来估计与CRH使用相关的基层医疗质量指标的变化。结果以百分比形式报告。
107家倾向匹配的VHA诊所的全国队列，这些诊所使用和未使用CRH基层医疗服务
CRH基层医疗服务
慢性病质量指标
对于糖尿病质量指标，我们发现使用CRH的诊所与其对照诊所之间结果相似，包括年度糖化血红蛋白（HbA1c）筛查（百分比差异为0.0%（-1.0%，1.0%），p = 0.640）、HbA1c控制不佳（-1.0%（-1.0%，0.0%），p = 0.111）、糖尿病退伍军人的血压控制（1.0%（-0.0%，3.0%），p = 0.095）、糖尿病退伍军人的他汀类药物治疗（1.0%（0.0%，1.0%），p = 0.003）、糖尿病退伍军人的他汀类药物依从性（0.0%（-1.0%，0.0%），p = 0.292）以及肾病筛查（1.0%（0.0%，1.0%），p = 0.010）。诊所组之间在血压控制方面没有差异（1.0%（-1.0%，2.0%），p = 0.382）。对于心血管质量指标，包括心血管疾病退伍军人的他汀类药物治疗（0.0%（-1.0%，2.0%），p = 0.348）以及心血管疾病退伍军人的他汀类药物依从性（-1.0%（-3.0%，1.0%），p = 0.467），我们发现诊所组之间没有差异。在为高比例少数族裔退伍军人服务的诊所中也发现了类似结果。
我们发现使用CRH的诊所的质量指标与匹配的对照诊所相似。这些发现表明，像CRH这样的远程医疗干预措施可以在各种环境中改善初级卫生保健的可及性，而不会影响基层医疗质量。
