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2023 HSR&D/QUERI National Conference Abstract

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1061 — Leveraging VA Tablets to Support My HealtheVet Adoption and Use

Lead/Presenter: Ashley Griffin,  COIN - Palo Alto
All Authors: Griffin AC (Center for Innovation to Implementation, Stanford University School of Medicine), Troszak LK (Center for Innovation to Implementation, Stanford University School of Medicine) Van Campen J (Center for Innovation to Implementation, Stanford University School of Medicine) Midboe AM (Center for Innovation to Implementation, Stanford University School of Medicine) Zulman DM (Center for Innovation to Implementation, Stanford University School of Medicine)

Objectives:
To examine whether distribution of VA-issued tablets to Veterans with access barriers influences their adoption and use of the VA’s My HealtheVet (MHV) patient portal.

Methods:
We conducted a retrospective cohort study among Veterans (n = 28,659) who received a tablet between November 1, 2020 and April 30, 2021. Veterans were included if they had an outpatient encounter in the 6 months before tablet receipt and had the tablet for at least 6 months. All tablets included a bookmarked icon for MHV on the home screen. The primary outcomes were MHV registration and use of key MHV features during the 6 months post-tablet. These features included: view message, send message, view prescription refills, request prescription refills, view appointments, schedule or request appointments, view labs, or download personal data (Blue Button). First, we characterized tablet recipients by grouping them into three MHV baseline user types (non-users, inactive users, and active users) based on MHV registration status and feature use pre-tablet receipt. Next, three multivariable models were estimated to examine the factors predicting 1) MHV registration among non-users, 2) any MHV feature use among inactive users, and 3) increased MHV use among active users post-tablet receipt. Lastly, we examined temporal patterns across each user group by visualizing the daily number of Veterans who used each key feature relative to the date of tablet shipment or MHV registration. Differences in feature use during the 6 months pre/post tablet were examined with McNemar chi-squared test of proportions.

Results:
In the 6 months post-tablet, 1,298 (8%) non-users registered, 525 (24%) inactive users used at least one feature, and 4,234 (46%) active users increased feature use. Across Veteran characteristics, there were differences in registration and feature use post-tablet, particularly among older adults and those without prior use of video visits (p < 0.01). For the temporal trends, MHV was most commonly used during the first month post-tablet and post-registration. Among active users, use of all features increased during the 6 months post-tablet receipt when compared to the 6 months pre-tablet receipt, with the greatest differences in viewing prescription refills and scheduling appointments (p < 0.01).

Implications:
Providing Veterans who experience barriers to in-person care with a device to access MHV showed potential to support patient portal adoption and use. We observed how certain patient characteristics were associated with higher odds of registration and using MHV following tablet receipt, and only a small percentage of tablet recipients registered after receiving a tablet. The VA could consider augmenting the current tablet set-up support to include MHV training and resources when a Veteran first receives a tablet.

Impacts:
Elucidating the characteristics of Veterans who adopt and use MHV following tablet receipt can inform VA implementation strategies and policies that support technology engagement and access to health information. Findings from this evaluation suggest that distribution of MHV-enabled devices holds promise but may not be sufficient to facilitate Veteran registration and use of the patient portal. Additional strategies are needed to promote MHV registration and digital inclusion among some subgroups of Veterans.