A Longitudinal Evaluation of a Novel Short-Term Staffing and Telehealth Program: A Retrospective Observational Study

Primary care is foundational to health, but provider shortages impact access. In the Veterans Health Administration (VHA), Clinical Resource Hubs (CRH) provide remote clinicians to alleviate short term staffing gaps.

A longitudinal analysis of primary care clinics from October 1, 2020, through September 30, 2024, was conducted. CRH user clinics were those with ≥10 CRH visits/month in 2 consecutive months. A time-varying measure of minimal threshold CRH use (ie, ≥10 CRH visits/month) was also constructed. Outcomes were measured monthly, including established and new patient wait time, third next available appointment (ie, average time to the third open appointment in provider schedule), timely care, and an indicator that 80% of new patients were seen within 20 days. Using a within-between model framework, generalized linear mixed models with robust standard errors assessed the association between CRH use and access to care.

Overall, 37.1% of VHA primary care clinics (N = 366) were CRH users In adjusted models, clinics meeting the time-varying minimal threshold for CRH use versus not was associated with an increase in established patient wait time (β = .35 day, SE = 0.07, P < .001) and new patient wait time (β = .69 day, SE = 0.20, P < .001), and a decrease in timely care (β = -1.40%, SE = 0.21, P < .001).

When CRH was engaged, clinics had marginally longer wait times. Though CRHs have provided remote staffing, additional efficiencies may be needed to close access gaps.