The telehealth engagement measure: a proportions-based measure of care delivered via video and phone for research, clinical, and policy assessments.

Objectives: In the absence of standardized measures, researchers have struggled to define meaningful use of telehealth (care received via video or telephone). We evaluated a novel Telehealth Engagement Measure (TEM) that quantifies an individual's telehealth use, including telephone (TEM-t) and video (TEM-v), as a percentage of total care received. Materials and Methods: In a retrospective cohort in the Veterans Health Administration (VHA), we identified 716,373 Veterans with at least three primary care visits between May 1, 2022 and April 31, 2023. We calculated the predicted annual TEM, TEM-t, and TEM-v stratified by age, gender, race/ethnicity, rurality, drive time, and Charlson Comorbidity Index, adjusting for patient demographics. Results: The mean unadjusted TEM was 21.7%, TEM-t was 15.1%, and TEM-v was 6.6%. The predicted annual TEM decreased with higher age until age 80 (15.1% (95% CI 14.7,15.5)). This was driven by reduced video care utilization, which peaked at 11.2% (95% CI 10.7,11.8) among Veterans aged 20 and declined after age 50 (6.5%, 95% CI 6.2, 6.8). A higher drive-time to VHA was associated with a higher TEM, while Veterans with higher comorbidity were associated with a higher TEM-t. Discussion: The TEM reflects the distribution of a person's care across different modalities The measure can be applied in research and clinical settings and can be leveraged to examine the longitudinal impact of telehealth on a host of outcomes. Conclusion: The TEM is a novel, proportions-based measure that can be used to assess telehealth utilization at various levels in a health care system.