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

BackgroundAccess to specialty care, including cardiology, in the Veterans Health Administration (VHA) varies widely across geographic regions. VHAs 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. How implementation of this predominantly virtual cardiology program affects the reach of cardiology specialty care in VHA is not known. This study describes the association between patient characteristics and use of CRH cardiology care in VHAs Sierra Pacific region (Northern California, Nevada, and the Pacific Islands). MethodsWe 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. ResultsThere were 804 CRH users over the study period with 1,961 CRH encounters, and 19,583 non-CRH users with 83,489 encounters. Among CRH users, 8% were women and 41% were [≥]75 years, compared to 5% and 49% respectively among non-CRH users. Similar proportions in both groups were rural (26% for both CRH and non-CRH), highly-disabled (48% CRH, 47% non-CRH), and low-income (21% CRH, 20% non-CRH). In multivariate logistic models, adjusted odds of using CRH were higher for women (adjusted odds ratio [AOR] 1.70 [95% CI 1.46-1.98]) and lower for older Veterans (AOR 0.33 for [≥]75 [95% CI 0.23-0.48]). Highly rural Veterans also had higher adjusted odds of using CRH (AOR 1.88 [95% CI 1.30-2.69]). ConclusionsThe Sierra Pacific CRH cardiology program served a disproportionately high number of women and highly rural Veterans and similar proportions of highly-disabled and low-income Veterans as conventional VA care 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.