Travel Time to Nearest Medical Center, Continuity of Care, and Electronic Health Information Exchange

Turvey CL, Klein DM, Nazi KM. Travel Time to Nearest Medical Center, Continuity of Care, and Electronic Health Information Exchange. Poster session presented at: VA Rural Health State of the Science Conference; 2016 Sep 21; Washington, DC.

Objectives: This nationwide survey of My HealtheVet Users explored the relation between travel time to the nearest facility, continuity of care, and awareness of and participation in VA's electronic health information exchange programs. Methods: 27,808 Veterans were surveyed nationwide while using My HealtheVet, VA's Patient Portal. Of these 27,808, 12,504 (45%) indicated receiving care from a non-VA provider. Dual use respondents were asked three questions adapted from the Commonwealth Fund's Care Coordination measure. They were also asked about their awareness of VA's electronic health information access and exchange programs, the My HealtheVet Blue Button and Veterans Health Information Exchange (VHIE). Results: Veterans living at further travel time from the nearest VA reported significantly worse continuity of care as evidenced by higher endorsement of unavailability of medical test results from outside organizations (p = 0.001); duplicate laboratory testing (p = 0.001); and receipt of conflicting information from VA and community providers (p = 0.001). For each item, there was a clear graded decrease in continuity corresponding to increased travel time to the nearest VA Care Continuity Metric: Percent endorsing by travel time group. Unavailable Test Results: Less than 30 minutes- 17%, 30 to 60 minutes- 20%, 61 - 90 minutes- 25%, 91 minutes to two hours- 28%, Over two hours- 30%; Laboratory Duplication: Less than 30 minutes- 7%, 30 to 60 minutes- 8%, 61 - 90 minutes- 10%, 91 minutes to two hours- 11%, Over two hours- 12%; VA and Community Provider Information Conflicts: Less than 30 minutes- 13%, 30 to 60 minutes- 15%, 61 - 90 minutes- 18%, 91 minutes to two hours- 23%, Over two hours- 25%; There was little to no association between travel time and awareness of My HealtheVet Blue Button (range 53-56%) or VLER (range 20 - 21%) and small differences actual use of VA health information programs (My HealtheVet Blue Button range 65-73%; VHIE Range 26-31%). Conclusions: My HealtheVet users with greater travel distance to the nearest VA report lower continuity of care. However, awareness of VA's Blue Button and VLER health information programs was similar across travel distance groups. Impact: In this nationwide sample of My HealtheVet users, greater travel time to nearest VA is associated with greater gaps in care continuity. There is still great opportunity for VA to promote Veteran adoption of electronic health information exchange to reduce these gaps.