The Clinical Resource Hub Telehealth Program and Use of Primary Care, Emergency, and Inpatient Care During the COVID-19 Pandemic.

The Clinical Resource Hub Telehealth Program and Use of Primary Care, Emergency, and Inpatient Care During the COVID-19 Pandemic.

Publication date: Jan 22, 2024

The COVID-19 pandemic disrupted delivery of health care services worldwide. We examined the impact of the pandemic on clinics participating in the Veterans Affairs (VA) Clinical Resource Hub (CRH) program, rolled out nationally in October 2019, to improve access to care at under-resourced VA clinics or “spoke” sites through telehealth services delivered by regional “hub” sites. To assess whether the CRH program was associated with increased access to primary care, we compared use of primary, emergency, and inpatient care at sites that adopted CRH for primary care (CRH-PC) with sites that did not adopt CRH-PC, pre-post pandemic onset. Difference-in-difference and event study analyses, adjusting for site characteristics. A total of 1050 sites (254 CRH-PC sites; 796 comparison sites), fiscal years (FY) 2019-2021. CRH Program for Primary Care. Quarterly number of VA visits per site for primary care (across all and by modality, in-person, video, and phone), emergency care, and inpatient care. In adjusted analyses, CRH-PC sites, compared with non-CRH-PC sites, had on average 221 additional primary care visits (a volume increase of 3. 4% compared to pre-pandemic). By modality, CRH-PC sites had 643 fewer in-person visits post-pandemic (- 14. 4%) but 723 and 128 more phone and video visits (+ 39. 9% and + 159. 5%), respectively. CRH-PC sites, compared with non-CRH-PC sites, had fewer VA ED visits (- 4. 2%) and hospital stays (- 5. 1%) in VA medical centers. Examining visits per patient, we found that CRH-PC sites had 48 additional telephone primary care visits per 1000 primary care patients (an increase of 9. 8%), compared to non-program sites. VA’s pre-pandemic rollout of a new primary care telehealth program intended to improve access facilitated primary care visits during the pandemic, a period fraught with care disruptions, and limited in-person health care delivery, indicating the potential for the program to offer health system resilience.

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Concepts Keywords
Inpatient Care
Pandemic Clinical
Veterans Compared


Type Source Name
drug DRUGBANK Huperzine B
disease MESH Emergency
disease MESH COVID-19 Pandemic
disease MESH access to primary care
disease IDO site
disease VO volume
disease VO USA
disease IDO intervention
drug DRUGBANK Coenzyme M
disease MESH infection
drug DRUGBANK Etoperidone
drug DRUGBANK Esomeprazole
disease MESH Comorbidity
disease VO time
drug DRUGBANK Ademetionine
drug DRUGBANK Serine
drug DRUGBANK Tretamine
disease VO population
drug DRUGBANK Methylphenidate
pathway REACTOME Reproduction
drug DRUGBANK Pentaerythritol tetranitrate
disease VO Canada
disease VO Gap
drug DRUGBANK L-Aspartic Acid
drug DRUGBANK Trestolone
drug DRUGBANK Indoleacetic acid
disease VO study design

Original Article

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