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2019 HSR&D/QUERI National Conference Abstract

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4035 — Use of VA Telehealth during Hurricane Harvey

Lead/Presenter: Claudia Der-Martirosian,  COIN - Los Angeles
All Authors: Der-Martirosian C (Veterans Evaluation Management Center (VEMEC), VA Greater Los Angeles), Chu K (Veterans Emergency Management Evaluation Center, VA Greater Los Angeles), Dobalian A, (Veterans Emergency Management Evaluation Center, VA Greater Los Angeles)

Objectives:
When continuity of routine, face-to-face care was disrupted during the 2017 and 2018 hurricane seasons, many VA clinicians used telehealth (TH) to provide virtual care. This study examines the use of VA telehealth services at the Houston VA Medical Center (VAMC) before and after Hurricane Harvey (8/25/2017), the first major hurricane to strike the US since Superstorm Sandy (10/29/2012).

Methods:
Using outpatient workload data from the VA Corporate Data Warehouse, a national repository of clinical and administrative data from all VA medical facilities, we extracted detailed information on each clinical visit for VA-users who accessed the Houston VAMC at least once during the 24 months prior to Harvey's landfall. Daily utilization of all TH services was compared to non-TH outpatient services 30-days before and 30-days after Harvey. Three TH study cohorts were identified 14-days before and 14-days after Harvey. Patients who used TH services at Houston VAMC: before and after; only before; only after, Harvey.

Results:
Thirty days before Harvey, an average of 10% of all Houston VAMC outpatient visits every day were for telehealth services. However, telehealth use peaked at 42% at 6 days post-Harvey. There was a substantial increase in the following telehealth services: mental health, home non-video monitoring, home-based primary care and HUD-VASH, a program for homeless Veterans. In contrast, there was a modest decrease for primary care, triage, and ancillary services after Harvey. When compared to the other two Houston study cohorts, the first cohort had a slightly higher average age and a substantially higher average number of outpatient visits 24-months before Harvey.

Implications:
During major crises such as natural disasters, the VA, which is the largest integrated healthcare delivery system in the US, has the capacity to transition from in-person care to telecare to ensure continued access to care for many health services. More research is needed to identify how telehealth can be used to minimize disruptions in access to care during major disasters, particularly for small and independent facilities.

Impacts:
Use of telehealth services during disasters can increase access to care and decrease disruption of health services for all VA patients including vulnerable patient populations.