Overcoming Access Barriers for Veterans: Cohort Study of the Distribution and Use of Veterans Affairs’ Video-Enabled Tablets Before and During the COVID-19 Pandemic

Abstract

Background During the COVID-19 pandemic, as health care services shifted to video- and phone-based modalities for patient and provider safety, the Veterans Affairs (VA) Office of Connected Care widely expanded its video-enabled tablet program to bridge digital divides for veterans with limited video care access. Objective This study aimed to characterize veterans who received and used US Department of VA–issued video-enabled tablets before versus during the COVID-19 pandemic. Methods We compared sociodemographic and clinical characteristics of veterans who received VA-issued tablets during 6-month prepandemic and pandemic periods (ie, from March 11, 2019, to September 10, 2019, and from March 11, 2020, to September 10, 2020). Then, we examined characteristics associated with video visit use for primary and mental health care within 6 months after tablet shipment, stratifying models by timing of tablet receipt. Results There was a nearly 6-fold increase in the number of veterans who received tablets in the pandemic versus prepandemic study periods (n=36,107 vs n=6784, respectively). Compared to the prepandemic period, tablet recipients during the pandemic were more likely to be older (mean age 64 vs 59 years), urban-dwelling (24,504/36,107, 67.9% vs 3766/6784, 55.5%), and have a history of housing instability (8633/36,107, 23.9% vs 1022/6784, 15.1%). Pandemic recipients were more likely to use video care (21,090/36,107, 58.4% vs 2995/6784, 44.2%) and did so more frequently (5.6 vs 2.3 average encounters) within 6 months of tablet receipt. In adjusted models, pandemic and prepandemic video care users were significantly more likely to be younger, stably housed, and have a mental health condition than nonusers. Conclusions Although the COVID-19 pandemic led to increased distribution of VA-issued tablets to veterans with complex clinical and social needs, tablet recipients who were older or unstably housed remained less likely to have a video visit. The VA’s tablet distribution program expanded access to video-enabled devices, but interventions are needed to bridge disparities in video visit use among device recipients.

Development and Validation of a Measure to Assess Patient Experiences With Video Care Encounters

“…Quantitative psychometric data were collected as part of a survey that was conducted to assess access to and user experience of virtual care among VHA patients. This included veterans enrolled in a digital access program whereby those with clinical needs who lack the appropriate technology or infrastructure (devices, broadband, or internet access) can receive a video-enabled tablet and data plan for video-based care from home . A national multimode survey was linked to VHA administrative data to prospectively ascertain video visit utilization over the 6 months after the survey.…”

“…Characteristics of the most recent video visit, gender, and race and ethnicity (categorized as African American, Hispanic/Latino, White, and other, which included American Indian or Alaska Native, Asian, Native Hawaiian/other Pacific Islander, other, and >1 race) were self-reported from survey respondents. Data on race and ethnicity were collected in an effort to include demographic and social variables that have demonstrated an association with video visit use in prior work …”

“…Predictive validity was examined using logistic regression to model the odds of 1 or more video visit among veterans with any outpatient health care utilization in the 6 months following the survey. Odds of video visit use were modeled as a function of VVUE scores, adjusting for patient characteristics that are associated with video visit utilization: age, race and ethnicity, sex, marital status, geographic area, and chronic physical and mental health conditions . We plotted marginal estimated probabilities over the continuum of VVUE scores to illustrate this association.…”

“…The Veterans Healthcare Administration (VHA), a longstanding investor in telehealth, has made comprehensive efforts to implement, improve, and expand utilization of telehealth services (including video visits) to facilitate access to care, with rapid expansion during the COVID-19 pandemic . Several programs exist to promote access to video visits and bridge the digital divide, including making data services free of charge for health care use, and distribution of tablets to veterans who lack internet-enabled devices and broadband access . This makes the large nationwide VHA system an ideal environment to develop and test a video visit patient experience measure.…”

“…23 Several programs exist to promote access to video visits and bridge the digital divide, including making data services free of charge for health care use, and distribution of tablets to veterans who lack internet-enabled devices and broadband access. 23 , 24 , 25 , 26 This makes the large nationwide VHA system an ideal environment to develop and test a video visit patient experience measure.…”