Observational studyJournal of general internal medicine2023
Travel Burden as a Measure of Healthcare Access and the Impact of Telehealth within the Veterans Health Administration.
Observational study in Journal of general internal medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05419323 (Improving Access to Sleep Apnea Care), which is not on this map. Cited by 21 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Improving Access to Sleep Apnea Care: A Pragmatic Study of New Consultation Models
Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.
- Reducing outpatient wait times through telemedicine: a systematic review and quantitative analysis.BMJ open · 2025Pooled it
- Digital Literacy and Patient Satisfaction in Telemedicine Follow-Up With In-Person App Instruction Versus Outpatient Department Follow-Up After Upper-Extremity Surgery: A Randomized Controlled Trial.Journal of medical Internet research · 2026Trial
- The tracking and reducing alcohol consumption (TRAC) intervention for veterans living with HIV/AIDS: results from a pilot randomized waitlist-controlled trial.Addiction science & clinical practice · 2025Trial
- A mixed methods analysis of health literacy among adults with brachial plexus birth injury.Journal of pediatric rehabilitation medicine · 2026Article
- Five Milestones to Addressing Rural Veteran Care Coordination, Care Management, and Case Management Needs: An Integrated Case Management Practice Framework.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
- Bridging Gaps in Acute Care Access for Rural Veterans: The Reach and Impact of VA's Virtual Emergency and Urgent Care Programs.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
- Beyond Geography: Using a Cluster-Based Analysis to Conceptualize the Rurality of Veterans Health Administration Hospitals.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
- Telemedicine Reimbursement Changes and Health Care Contact Days for Older Adults.JAMA network open · 2026Article
- Neighborhood-level socioeconomic disadvantage and pancreatic cancer among veterans.JNCI cancer spectrum · 2026Article
- Post-Intensive Care Fragmentation Among Rural Veterans: Transitions Between VA and Community Health Systems.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
- Patient-centered burdens and economic outcomes among patients who are veterans, people with intellectual and developmental disabilities, and people living in rural areas and their caregivers: a scoping review.Frontiers in public health · 2026Article
- Health care access from the rural perspective: A narrative review.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Review
- Article
- Family profiles in relation to early childhood caries: a cross-sectional study in France.BMJ open · 2025Observational
- An approach to evaluating the impact of virtual specialty care: the Veterans Health Administration's clinical resource hub as case study.JAMIA open · 2025Review
- Decarbonizing Health Care: Measuring the Carbon Footprint Impact of a National VA Telehealth Program.NEJM catalyst innovations in care delivery · 2025Article
- Supporting Physical and Mental Health in Rural Veterans Living With Heart Failure: Protocol for a Nurse-Led Telephone Intervention Study.JMIR research protocols · 2025Article
- Stakeholder Perspectives on Telehealth Effectiveness, Facilitators, and Barriers for Wheelchair Service Provision: A Needs Analysis.International journal of telerehabilitation · 2025Article
- Transforming Veteran Rehabilitation Care: Learnings from a Remote Digital Approach for Musculoskeletal Pain.Healthcare (Basel, Switzerland) · 2024Article
- Human technology intermediation to reduce cognitive load: understanding healthcare staff members' practices to facilitate telehealth access in a Federally Qualified Health Center patient population.Journal of the American Medical Informatics Association : JAMIA · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTravel is a major barrier to healthcare access for Veteran Affairs (VA) patients, and disproportionately affects rural Veterans (approximately one quarter of Veterans). The CHOICE/MISSION acts' intent is to increase timeliness of care and decrease travel, although not clearly demonstrated. The impact on outcomes remains unclear. Increased community care increases VA costs and increases care fragmentation. Retaining Veterans within the VA is a high priority, and reduction of travel burdens will help achieve this goal. Sleep medicine is presented as a use case to quantify travel related barriers.
objectiveThe Observed and Excess Travel Distances are proposed as two measures of healthcare access, allowing for quantification of healthcare delivery related to travel burden. A telehealth initiative that reduced travel burden is presented.
designRetrospective, observational, utilizing administrative data. SUBJECTS: VA patients with sleep related care between 2017 and 2021. In-person encounters: Office visits and polysomnograms; telehealth encounters: virtual visits and home sleep apnea tests (HSAT). MAIN MEASURES: Observed distance: distance between Veteran's home and treating VA facility. Excess distance: difference between where Veteran received care and nearest VA facility offering the service of interest. Avoided distance: distance between Veteran's home and nearest VA facility offering in-person equivalent of telehealth service. KEY
resultsIn-person encounters peaked between 2018 and 2019, and have down trended since, while telehealth encounters have increased. During the 5-year period, Veterans traveled an excess 14.1 million miles, while 10.9 million miles of travel were avoided due to telehealth encounters, and 48.4 million miles were avoided due to HSAT devices.
conclusionsVeterans often experience a substantial travel burden when seeking medical care. Observed and excess travel distances are valuable measures to quantify this major healthcare access barrier. These measures allow for assessment of novel healthcare approaches to improve Veteran healthcare access and identify specific regions that may benefit from additional resources.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.