{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T02:08:40Z","timestamp":1772849320725,"version":"3.50.1"},"reference-count":45,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n As telehealth (ie, telephone and video) becomes a larger component of primary care, understanding its impact on care quality is critical.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate whether the proportion of primary care received via telehealth is associated with differences in quality-of-care outcomes among veterans who frequently use primary care.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This is a retrospective cohort study of veterans empaneled to Veterans Health Administration (VHA) primary care in fiscal years 2022 and 2023 (October 1, 2021, to September 30, 2023) with 3 or more primary care visits. Telehealth proportion categories were none (0.0% primary care visits telehealth), low (&amp;gt;0.0% to &amp;lt;28.6%), intermediate (28.6% to &amp;lt;50.0%), or high (\u226550.0%).<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Proportion of primary care delivered via telehealth.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes were influenza vaccination, hypertension control, statin therapy and adherence, and screenings and\/or counseling for depression, tobacco, and alcohol use. Multivariable logistic regression was used to estimate adjusted average marginal effects (AMEs), controlling for sociodemographic, geographic, and clinical characteristics.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n This study included 744\u202f599 veterans (mean [SD] age, 65 [15] years; 638\u202f289 male [86%]). Compared with veterans receiving in-person care only, those who received a low proportion of care via telehealth had similar quality of outcomes for all cardiovascular and behavioral health measures. Influenza vaccination rates were modestly lower in the low-telehealth group vs the in-person only group (age \u226566 years, AME, \u22121.93% [95% CI, \u22122.58% to \u22121.29%]; age 19-65 years, AME, \u22121.57% [95% CI, \u22122.28% to \u22120.86%]). High telehealth users (\u226550% telehealth) had the lowest adjusted likelihoods for most quality outcomes, including influenza vaccination (age \u226566 years, AME, \u22128.96% [95% CI, \u22129.84% to \u22128.07%]; age 19-65 years, AME, \u22129.72% [95% CI, \u221210.84% to \u22128.60%]) statin adherence (AME, \u20132.03% [95% CI \u22122.93% to \u22121.14%]) and depression screening (AME, \u20132.14% [95% CI, \u22123.20% to \u22121.08%]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of veterans with 3 or more primary care visits, primary care quality was similar for individuals who received all in-person care and those receiving low or intermediate proportions of telehealth. However, high telehealth use was associated with lower quality for several services, especially those requiring in-person interaction. Findings demonstrate the viability of hybrid telehealth and in-person models. Additional resources might be needed to ensure high-quality primary care for high proportion telehealth users.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.59940","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T16:30:19Z","timestamp":1771345819000},"page":"e2559940","source":"Crossref","is-referenced-by-count":1,"title":["Primary Care by Telehealth and Care Quality in the Veterans Health Administration"],"prefix":"10.1001","volume":"9","author":[{"given":"Jonathan","family":"Staloff","sequence":"first","affiliation":[{"name":"Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington"},{"name":"Department of Family Medicine, University of Washington, Seattle"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Gunnink","sequence":"additional","affiliation":[{"name":"Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget 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