Evaluation of the Veterans Health Administration's Digital Divide Consult for Tablet Distribution and Telehealth Adoption: Cohort Study

Background: Video telehealth offers a mechanism to help Veterans Health Administration (VHA) patients overcome health. Bare access barriers; however, many veterans lack a suitable device and sufficient internet connectivity. To address disparities in technology access, VHA established a Connected Device Program that offers veterans loaned video-capable tablets and internet Service. In 2020, VHA introduced a national Digital Divide Consult to facilitate and standardize referrals for this resource. Objective: We sought to evaluate the reach and impact of VHA's Connected Device Program, leveraging Digital Divide Consult Eata to determine whether resources are supporting veterans with health care needs and access barriers. Methods: We examined the reach of VHA's Connected Device Program using national secondary data from VHAis electronic health records among 119,926 tablet recipients who received a tablet (April 1, 2020, to February 28, 2023) and 683,319 veterans from the general VHA population. We assessed changes in tablet recipients demographic and clinical characteristic before and after implementation of the Digital Divide Consult compared with the general VHA population. We examined the impact of ablets and the consult on adoption of telehealth (ie, video visit use and number of visits) adjusting for differences between tablet #ecipients and the general VHA population. Finally, we evaluated consult implementation by assessing the use of video-based Services by tablet referral reason. Results: Common reasons for tablet referral included mental health diagnoses (50,367/79,230, 63.9%), distance from a VHA Facility 30 miles (17,228/79,230, 21.7%), and social isolation (16,161/79,230, 20.4%). Moreover, 63.0% (49,923/79,230) of individuals who received a tablet after implementation of the Digital Divide Consult had a video visit in the first & months of tablet receipt. Some consult reasons were associated with a higher-than-average percentage of video telehealth use, including enrollment in evidence-based mental health programs (74.8% [830/1100] with video use), living >30 miles from a VHA facility 68.3% [10,557/17,228] with video use), and having a mental health diagnosis (68.1% [34,301/50,367] with video use). Tablet Pecipients had nearly 3 times the likelihood of having a video visit within a month once provided a tablet compared to the general VHA population, with an adjusted risk ratio of 2.95 (95% CI 2.91-2.99) before consult implementation and 2.73 (95% CI 2.70-2.76) after consult implementation. Analyses of telehealth adoption suggested that veterans receiving tablets for mental health care and vidence-based programs have higher rates of video visits, while those who are homebound or receiving tablets for Hospice have sigher rates of nonuse. Conclusions: This evaluation of VHA's Connected Device Program suggests that tablets are facilitating video-based care among veterans with complex needs. Standardization of referrals through the Digital Divide Consult has created opportunities to identify groups of tablet recipients with lower telehealth adoption rates who might benefit from a targeted intervention.