Early Implementation of a Regional Telehealth Contingency Staffing Program and Primary Care Quality in the Veterans Health Administration: Evidence from the Clinical Resource Hub program

BackgroundThe Veterans Health Administration (VHA) launched the Clinical Resource Hub (CRH) program to address primary care staffing deficits and improve access.ObjectiveTo determine if the quality of primary care at clinics that use CRH services was similar to that of clinics that did not. Secondarily, to examine this association for clinics that serve a high proportion of minority Veterans.DesignA quasi-experimental study using VHA administrative data from October 2017 through September 2021. We applied interrupted time series models to estimate changes in primary care quality measures associated with CRH utilization. Results are reported as percentages.ParticipantsNational cohort of 107 propensity-matched VHA clinics that did and did not use CRH primary care servicesIntervention(s)CRH primary care servicesMain Measure(s)Chronic disease quality measuresKey ResultsFor diabetes quality measures, we found similar results between CRH-utilizing clinics and their controls, including annual HbA1c screening (0.0% percentage difference (-1.0%, 1.0%), p = 0.640), poor HbA1c control (-1.0% (-1.0%, 0.0%), p=0.111), control of blood pressure for Veterans with diabetes (1.0% (-0.0%, 3.0%), p=0.095), statin therapy for Veterans with diabetes (1.0% (0.0%, 1.0%), p=0.003), statin adherence for Veterans with diabetes (0.0% (-1.0%, 0.0%), p=0.292), and nephropathy screening (1.0% (0.0%, 1.0%), p=0.010). There were no differences between clinic groups for control of blood pressure (1.0% (-1.0%, 2.0%), p=0.382). For cardiovascular quality measures, including statin therapy for Veterans with cardiovascular disease (0.0% (-1.0%, 2.0%), p=0.348), and statin adherence for Veterans with cardiovascular disease (-1.0% (-3.0%, 1.0%), p=0.467), we found no differences between clinic groups. Similar results were found among clinics that serve a high proportion of minority Veterans.ConclusionsWe found that quality measures at CRH-utilizing clinics are similar to matched comparator clinics. These findings demonstrate that telehealth interventions, like CRH, can improve access to primary health care in a variety of settings, without impacting the quality of primary care.