Abstract 14947: Opportunities to Address Specialty Care Deserts and the Digital Divide: VA’s Virtual Hub-and-Spoke Cardiology Clinic

Abstract

Introduction: Access to specialty care, including cardiology, in the Veterans Health Administration (VA) varies widely across geographic regions. VA’s clinical resource hub (CRH) model of care offers mostly-virtual specialty care to individuals in low access regions and has recently been implemented in cardiology. Research Question: How does implementation of a predominantly virtual care cardiology program through CRH affect the reach of cardiology specialty care in the VA? Aims: Describe the association between patient characteristics and use of CRH cardiology care in VA’s Sierra Pacific region (Northern California, Nevada, and the Pacific Islands). Methods: We compared patients who used CRH cardiology services between 7/15/2021 and 3/31/2023 to non-CRH Sierra Pacific cardiology patients, then used multivariate logistic regression to estimate the association between patient-level factors and odds of being a CRH user. Results: There were 798 CRH users over the study period with a total of 3,662 cardiology encounters, 1,690 of which were CRH encounters. Of these, 8% of CRH users were women and 41% were ≥75 years, compared to 4% and 48% respectively among non-CRH users [n=25,412 with 95,663 encounters]. Similar proportions in both groups were rural (26% CRH, 25% non-CRH), highly-disabled (48% CRH, 47% non-CRH), and low-income (20% in both groups). In multivariate logistic models, adjusted odds of using CRH were higher for women (adjusted odds ratio [AOR] 1.45 [95% CI 1.09-1.92]) and lower for older Veterans (AOR 0.44 for ≥75 [95% CI 0.0.32-0.61]). Conclusions: The Sierra Pacific CRH cardiology program served a disproportionately high number of women and similar proportions of rural, highly-disabled, and low-income Veterans in its first two years of operation. This predominately-virtual model of cardiology care may be an effective strategy for overcoming access barriers for certain individuals, though targeted efforts may be required to reach older Veterans.