Sociodemographic patterns of provider-to-home telehealth use within the Veterans Health Administration between 2015 and 2023

Abstract Background The VHA is the largest healthcare system in the US and an early adopter of telehealth. Barriers to adoption may exist among subpopulations of VHA patients. Objective To identify patterns in use of telehealth by modality, race, rurality, age and priority group before and during the COVID-19 pandemic. Design We used data from the VHA Pyramid Analytics database to determine quarterly telehealth utilization rates from October 2015 to March 2023 using a pre-post analysis. Main measures were stratified by race, rurality, age group, and VA priority groups. Participants Unique patients who used any VHA care within each Fiscal Year of the study period. Interventions N/A. Main Measures Quarterly encounters by modality and number of users with one or more Provider to Home (PTH) encounters per 1000 unique patients. Key Results There were 36,315,299 telehealth encounters completed by 4,597,055 users during the analytic period. From October 2015–March 2020, PTH video encounters grew from 3.2% of VHA telehealth encounters to 38%. From April 2020–March 2023, PTH video encounters accounted for 90.7% of VHA telehealth encounters. Uptake of PTH during the pandemic differed significantly between demographic groups. Quarterly users per 1000 unique patients (increase relative to reference group; p-values