National Telehealth Contingency Staffing Program and Primary Care Quality in the VHA.

Importance: The Veterans Health Administration (VHA) launched the Clinical Resource Hub (CRH), a national telehealth contingency staffing program, to address primary care staffing shortages and improve veteran access to primary care. How this large-scale telehealth intervention affects quality of care is unknown. Objective: To assess the quality of care for chronic disease management among US veterans receiving high vs low levels of CRH-delivered primary care services and whether racial and ethnic minority veterans experience outcomes similar to those of White veterans when receiving CRH-delivered care. Design, Setting, and Participants: This retrospective quality improvement study was conducted using VHA administrative data. Veterans receiving primary care services from CRH clinicians between October 1, 2022, to September 30, 2023, were included. Exposures: Low, medium, and high tertiles of CRH intensity, defined as the proportion of a veteran's CRH primary care visits to their total primary care visits within the study period. Main Outcomes and Measures: The main outcomes were chronic disease quality measures for 2 common conditions in ambulatory care: diabetes and hypertension. Logistic regression models were used to estimate the association between individual-level receipt of care from a CRH clinician and the study outcomes. Results: This study included 71 508 veterans (mean [SD] age, 66 [15] years; 91.4% were male). Veterans who received a higher proportion of care from CRH clinicians were more likely to have improved blood pressure control compared with those who received a lower proportion of care. Higher vs lower CRH intensity was associated with improved blood pressure control among veterans with diabetes (79.5% [95% CI, 78.5%-80.4%] vs 76.6% [95% CI, 75.7%-77.5%]) and veterans with hypertension (76.8% [95% CI, 76.0%-77.5%] vs 73.9% [95% CI, 73.2%-74.7%]). Among racial and ethnic minority veterans, no association between CRH intensity and clinical quality was observed. Conclusions and Relevance: In this large retrospective cohort study among veterans receiving primary care services through a national telehealth contingency staffing program, veterans with a higher proportion of care from CRH clinicians had improvement in blood pressure outcomes. These findings suggest that the CRH program may be helpful in addressing veteran primary care needs without introducing or worsening disparities in ambulatory quality measures among racial and ethnic minority veterans. As health systems face staffing shortages in primary care, these findings can inform strategies for equitable implementation of large-scale telehealth initiatives to fill these gaps and maintain timely access to primary care.