{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T15:48:12Z","timestamp":1778082492677,"version":"3.51.4"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"3","funder":[{"name":"Career Development Award","award":["19-120"],"award-info":[{"award-number":["19-120"]}]},{"name":"US Department of Veterans Affairs Health Services Research and Development Service"},{"name":"Quality Enhancement Research Imitative","award":["PEI 18-205"],"award-info":[{"award-number":["PEI 18-205"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To describe the shift from in-person to virtual care within Veterans Affairs (VA) during the early phase of the COVID-19 pandemic and to identify at-risk patient populations who require greater resources to overcome access barriers to virtual care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Outpatient encounters (N\u2009=\u200942\u00a0916\u00a0349) were categorized by care type (eg, primary, mental health, etc) and delivery method (eg, in-person, video). For 5\u00a0400\u00a0878 Veterans, we used generalized linear models to identify patient sociodemographic and clinical characteristics associated with: 1) use of virtual (phone or video) care versus no virtual care and 2) use of video care versus no video care between March 11, 2020 and June 6, 2020.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>By June, 58% of VA care was provided virtually compared to only 14% prior. Patients with lower income, higher disability, and more chronic conditions were more likely to receive virtual care during the pandemic. Yet, Veterans aged 45\u201364 and 65+ were less likely to use video care compared to those aged 18\u201344 (aRR 0.80 [95% confidence interval (CI) 0.79, 0.82] and 0.50 [95% CI 0.48, 0.52], respectively). Rural and homeless Veterans were 12% and 11% less likely to use video care compared to urban (0.88 [95% CI 0.86, 0.90]) and nonhomeless Veterans (0.89 [95% CI 0.86, 0.92]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Veterans with high clinical or social need had higher likelihood of virtual service use early in the COVID-19 pandemic; however, older, homeless, and rural Veterans were less likely to have video visits, raising concerns for access barriers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions and Relevance<\/jats:title>\n                  <jats:p>While virtual care may expand access, access barriers must be addressed to avoid exacerbating disparities.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocaa284","type":"journal-article","created":{"date-parts":[[2020,10,26]],"date-time":"2020-10-26T20:39:23Z","timestamp":1603744763000},"page":"453-462","source":"Crossref","is-referenced-by-count":219,"title":["Virtual care expansion in the Veterans Health Administration during the COVID-19 pandemic: clinical services and patient characteristics associated with utilization"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0027-387X","authenticated-orcid":false,"given":"Jacqueline M","family":"Ferguson","sequence":"first","affiliation":[{"name":"Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA"},{"name":"Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA"}]},{"given":"Josephine","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA"}]},{"given":"Maria","family":"Yefimova","sequence":"additional","affiliation":[{"name":"Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA"},{"name":"Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA"},{"name":"Office of Research Patient Care Services, Stanford Health Care, Stanford, California, USA"}]},{"given":"Liberty","family":"Greene","sequence":"additional","affiliation":[{"name":"Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA"},{"name":"Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA"}]},{"given":"Leonie","family":"Heyworth","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs Central Office, Office of Connected Care\/Telehealth, Washington, DC, USA"},{"name":"Department of Medicine, UC San Diego School of Medicine, San Diego, California, USA"}]},{"given":"Donna M","family":"Zulman","sequence":"additional","affiliation":[{"name":"Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA"},{"name":"Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA"}]}],"member":"286","published-online":{"date-parts":[[2020,10,30]]},"reference":[{"key":"2021030612284782300_ocaa284-B1","first-page":"1","article-title":"Expanding access through virtual care: the VA\u2019 s early experience with Covid-19","author":"Heyworth","year":"2020","journal-title":"NEJM Catal Innov Care Deliv"},{"key":"2021030612284782300_ocaa284-B2","doi-asserted-by":"crossref","DOI":"10.1089\/tmj.2020.0233","article-title":"Rapid increase in telemental health within the department of Veterans affairs during the COVID-19 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