Travel Burden as a Measure of Healthcare Access and the Impact of Telehealth within the Veterans Health Administration
Background Travel is a major barrier to healthcare access for Veteran Affairs (VA) patients, and disproportionately affects rural Veterans (approximately one quarter of Veterans). The CHOICE/MISSION acts’ intent is to increase timeliness of care and decrease travel, although not clearly demonstrated...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2023-07, Vol.38 (Suppl 3), p.805-813 |
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| container_title | Journal of general internal medicine : JGIM |
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| creator | Hahn, Zachary Hotchkiss, John Atwood, Charles Smith, Connor Totten, Annette Boudreau, Eilis Folmer, Robert Chilakamarri, Priyanka Whooley, Mary Sarmiento, Kathleen |
| description | Background
Travel is a major barrier to healthcare access for Veteran Affairs (VA) patients, and disproportionately affects rural Veterans (approximately one quarter of Veterans). The CHOICE/MISSION acts’ intent is to increase timeliness of care and decrease travel, although not clearly demonstrated. The impact on outcomes remains unclear. Increased community care increases VA costs and increases care fragmentation. Retaining Veterans within the VA is a high priority, and reduction of travel burdens will help achieve this goal. Sleep medicine is presented as a use case to quantify travel related barriers.
Objective
The Observed and Excess Travel Distances are proposed as two measures of healthcare access, allowing for quantification of healthcare delivery related to travel burden. A telehealth initiative that reduced travel burden is presented.
Design
Retrospective, observational, utilizing administrative data.
Subjects
VA patients with sleep related care between 2017 and 2021. In-person encounters: Office visits and polysomnograms; telehealth encounters: virtual visits and home sleep apnea tests (HSAT).
Main Measures
Observed distance: distance between Veteran’s home and treating VA facility. Excess distance: difference between where Veteran received care and nearest VA facility offering the service of interest. Avoided distance: distance between Veteran’s home and nearest VA facility offering in-person equivalent of telehealth service.
Key Results
In-person encounters peaked between 2018 and 2019, and have down trended since, while telehealth encounters have increased. During the 5-year period, Veterans traveled an excess 14.1 million miles, while 10.9 million miles of travel were avoided due to telehealth encounters, and 48.4 million miles were avoided due to HSAT devices.
Conclusions
Veterans often experience a substantial travel burden when seeking medical care. Observed and excess travel distances are valuable measures to quantify this major healthcare access barrier. These measures allow for assessment of novel healthcare approaches to improve Veteran healthcare access and identify specific regions that may benefit from additional resources. |
| doi_str_mv | 10.1007/s11606-023-08125-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10356728</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2839582759</sourcerecordid><originalsourceid>FETCH-LOGICAL-c475t-42531791299fef45be87964e0e5b935f980ebef8635e0c950ab0270fbfeaf1713</originalsourceid><addsrcrecordid>eNp9kUtv1DAUhS0EokPhD7BAltiwCfgRx_YKDRXQSkVsBraW47luXCXOYDuD-Pe4M0N5LFj5cb577r06CD2n5DUlRL7JlHakawjjDVGUiYY_QCsq6oW2Wj5EK6JU2yjJ2zP0JOdbQihnTD1GZ7z-ESbkCu03ye5hxO-WtIWIbcYWfwKblwR49vgS7FgGZ-tr7RzkKsctLgPgq2lnXbljNjDCcODw91CGEA_6VyiQbMwnC7zeTiGGXJItYY5P0SNvxwzPTuc5-vLh_ebisrn-_PHqYn3duFaK0rRMcCo1ZVp78K3oQUndtUBA9JoLrxWBHrzquADitCC2J0wS33uwnkrKz9Hbo-9u6SfYOoh1gNHsUphs-mFmG8zfSgyDuZn3hhIuOslUdXh1ckjztwVyMVPIDsbRRpiXbJiqUMc7ISv68h_0dl5SrPtVimuhmBS6UuxIuTTnnMDfT0OJucvVHHM1NVdzyNXwWvTizz3uS34FWQF-BHKV4g2k373_Y_sT3z-utg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2839582759</pqid></control><display><type>article</type><title>Travel Burden as a Measure of Healthcare Access and the Impact of Telehealth within the Veterans Health Administration</title><source>MEDLINE</source><source>SpringerNature Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Hahn, Zachary ; Hotchkiss, John ; Atwood, Charles ; Smith, Connor ; Totten, Annette ; Boudreau, Eilis ; Folmer, Robert ; Chilakamarri, Priyanka ; Whooley, Mary ; Sarmiento, Kathleen</creator><creatorcontrib>Hahn, Zachary ; Hotchkiss, John ; Atwood, Charles ; Smith, Connor ; Totten, Annette ; Boudreau, Eilis ; Folmer, Robert ; Chilakamarri, Priyanka ; Whooley, Mary ; Sarmiento, Kathleen</creatorcontrib><description>Background
Travel is a major barrier to healthcare access for Veteran Affairs (VA) patients, and disproportionately affects rural Veterans (approximately one quarter of Veterans). The CHOICE/MISSION acts’ intent is to increase timeliness of care and decrease travel, although not clearly demonstrated. The impact on outcomes remains unclear. Increased community care increases VA costs and increases care fragmentation. Retaining Veterans within the VA is a high priority, and reduction of travel burdens will help achieve this goal. Sleep medicine is presented as a use case to quantify travel related barriers.
Objective
The Observed and Excess Travel Distances are proposed as two measures of healthcare access, allowing for quantification of healthcare delivery related to travel burden. A telehealth initiative that reduced travel burden is presented.
Design
Retrospective, observational, utilizing administrative data.
Subjects
VA patients with sleep related care between 2017 and 2021. In-person encounters: Office visits and polysomnograms; telehealth encounters: virtual visits and home sleep apnea tests (HSAT).
Main Measures
Observed distance: distance between Veteran’s home and treating VA facility. Excess distance: difference between where Veteran received care and nearest VA facility offering the service of interest. Avoided distance: distance between Veteran’s home and nearest VA facility offering in-person equivalent of telehealth service.
Key Results
In-person encounters peaked between 2018 and 2019, and have down trended since, while telehealth encounters have increased. During the 5-year period, Veterans traveled an excess 14.1 million miles, while 10.9 million miles of travel were avoided due to telehealth encounters, and 48.4 million miles were avoided due to HSAT devices.
Conclusions
Veterans often experience a substantial travel burden when seeking medical care. Observed and excess travel distances are valuable measures to quantify this major healthcare access barrier. These measures allow for assessment of novel healthcare approaches to improve Veteran healthcare access and identify specific regions that may benefit from additional resources.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-023-08125-3</identifier><identifier>PMID: 37340257</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Apnea ; Community health care ; Health care ; Health services ; Health Services Accessibility ; Humans ; Internal Medicine ; Medicine ; Medicine & Public Health ; Original Research ; Patients ; Retrospective Studies ; Sleep ; Sleep disorders ; Telemedicine ; Travel ; Travel-Related Illness ; United States - epidemiology ; United States Department of Veterans Affairs ; Veterans ; Veterans Health</subject><ispartof>Journal of general internal medicine : JGIM, 2023-07, Vol.38 (Suppl 3), p.805-813</ispartof><rights>The author(s) 2023</rights><rights>2023. The author(s).</rights><rights>The author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-42531791299fef45be87964e0e5b935f980ebef8635e0c950ab0270fbfeaf1713</citedby><cites>FETCH-LOGICAL-c475t-42531791299fef45be87964e0e5b935f980ebef8635e0c950ab0270fbfeaf1713</cites><orcidid>0000-0002-5703-2957</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10356728/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10356728/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,41488,42557,51319,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37340257$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hahn, Zachary</creatorcontrib><creatorcontrib>Hotchkiss, John</creatorcontrib><creatorcontrib>Atwood, Charles</creatorcontrib><creatorcontrib>Smith, Connor</creatorcontrib><creatorcontrib>Totten, Annette</creatorcontrib><creatorcontrib>Boudreau, Eilis</creatorcontrib><creatorcontrib>Folmer, Robert</creatorcontrib><creatorcontrib>Chilakamarri, Priyanka</creatorcontrib><creatorcontrib>Whooley, Mary</creatorcontrib><creatorcontrib>Sarmiento, Kathleen</creatorcontrib><title>Travel Burden as a Measure of Healthcare Access and the Impact of Telehealth within the Veterans Health Administration</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>Background
Travel is a major barrier to healthcare access for Veteran Affairs (VA) patients, and disproportionately affects rural Veterans (approximately one quarter of Veterans). The CHOICE/MISSION acts’ intent is to increase timeliness of care and decrease travel, although not clearly demonstrated. The impact on outcomes remains unclear. Increased community care increases VA costs and increases care fragmentation. Retaining Veterans within the VA is a high priority, and reduction of travel burdens will help achieve this goal. Sleep medicine is presented as a use case to quantify travel related barriers.
Objective
The Observed and Excess Travel Distances are proposed as two measures of healthcare access, allowing for quantification of healthcare delivery related to travel burden. A telehealth initiative that reduced travel burden is presented.
Design
Retrospective, observational, utilizing administrative data.
Subjects
VA patients with sleep related care between 2017 and 2021. In-person encounters: Office visits and polysomnograms; telehealth encounters: virtual visits and home sleep apnea tests (HSAT).
Main Measures
Observed distance: distance between Veteran’s home and treating VA facility. Excess distance: difference between where Veteran received care and nearest VA facility offering the service of interest. Avoided distance: distance between Veteran’s home and nearest VA facility offering in-person equivalent of telehealth service.
Key Results
In-person encounters peaked between 2018 and 2019, and have down trended since, while telehealth encounters have increased. During the 5-year period, Veterans traveled an excess 14.1 million miles, while 10.9 million miles of travel were avoided due to telehealth encounters, and 48.4 million miles were avoided due to HSAT devices.
Conclusions
Veterans often experience a substantial travel burden when seeking medical care. Observed and excess travel distances are valuable measures to quantify this major healthcare access barrier. These measures allow for assessment of novel healthcare approaches to improve Veteran healthcare access and identify specific regions that may benefit from additional resources.</description><subject>Apnea</subject><subject>Community health care</subject><subject>Health care</subject><subject>Health services</subject><subject>Health Services Accessibility</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Research</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Sleep</subject><subject>Sleep disorders</subject><subject>Telemedicine</subject><subject>Travel</subject><subject>Travel-Related Illness</subject><subject>United States - epidemiology</subject><subject>United States Department of Veterans Affairs</subject><subject>Veterans</subject><subject>Veterans Health</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kUtv1DAUhS0EokPhD7BAltiwCfgRx_YKDRXQSkVsBraW47luXCXOYDuD-Pe4M0N5LFj5cb577r06CD2n5DUlRL7JlHakawjjDVGUiYY_QCsq6oW2Wj5EK6JU2yjJ2zP0JOdbQihnTD1GZ7z-ESbkCu03ye5hxO-WtIWIbcYWfwKblwR49vgS7FgGZ-tr7RzkKsctLgPgq2lnXbljNjDCcODw91CGEA_6VyiQbMwnC7zeTiGGXJItYY5P0SNvxwzPTuc5-vLh_ebisrn-_PHqYn3duFaK0rRMcCo1ZVp78K3oQUndtUBA9JoLrxWBHrzquADitCC2J0wS33uwnkrKz9Hbo-9u6SfYOoh1gNHsUphs-mFmG8zfSgyDuZn3hhIuOslUdXh1ckjztwVyMVPIDsbRRpiXbJiqUMc7ISv68h_0dl5SrPtVimuhmBS6UuxIuTTnnMDfT0OJucvVHHM1NVdzyNXwWvTizz3uS34FWQF-BHKV4g2k373_Y_sT3z-utg</recordid><startdate>20230701</startdate><enddate>20230701</enddate><creator>Hahn, Zachary</creator><creator>Hotchkiss, John</creator><creator>Atwood, Charles</creator><creator>Smith, Connor</creator><creator>Totten, Annette</creator><creator>Boudreau, Eilis</creator><creator>Folmer, Robert</creator><creator>Chilakamarri, Priyanka</creator><creator>Whooley, Mary</creator><creator>Sarmiento, Kathleen</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5703-2957</orcidid></search><sort><creationdate>20230701</creationdate><title>Travel Burden as a Measure of Healthcare Access and the Impact of Telehealth within the Veterans Health Administration</title><author>Hahn, Zachary ; Hotchkiss, John ; Atwood, Charles ; Smith, Connor ; Totten, Annette ; Boudreau, Eilis ; Folmer, Robert ; Chilakamarri, Priyanka ; Whooley, Mary ; Sarmiento, Kathleen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-42531791299fef45be87964e0e5b935f980ebef8635e0c950ab0270fbfeaf1713</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Apnea</topic><topic>Community health care</topic><topic>Health care</topic><topic>Health services</topic><topic>Health Services Accessibility</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Research</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Sleep</topic><topic>Sleep disorders</topic><topic>Telemedicine</topic><topic>Travel</topic><topic>Travel-Related Illness</topic><topic>United States - epidemiology</topic><topic>United States Department of Veterans Affairs</topic><topic>Veterans</topic><topic>Veterans Health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hahn, Zachary</creatorcontrib><creatorcontrib>Hotchkiss, John</creatorcontrib><creatorcontrib>Atwood, Charles</creatorcontrib><creatorcontrib>Smith, Connor</creatorcontrib><creatorcontrib>Totten, Annette</creatorcontrib><creatorcontrib>Boudreau, Eilis</creatorcontrib><creatorcontrib>Folmer, Robert</creatorcontrib><creatorcontrib>Chilakamarri, Priyanka</creatorcontrib><creatorcontrib>Whooley, Mary</creatorcontrib><creatorcontrib>Sarmiento, Kathleen</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hahn, Zachary</au><au>Hotchkiss, John</au><au>Atwood, Charles</au><au>Smith, Connor</au><au>Totten, Annette</au><au>Boudreau, Eilis</au><au>Folmer, Robert</au><au>Chilakamarri, Priyanka</au><au>Whooley, Mary</au><au>Sarmiento, Kathleen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Travel Burden as a Measure of Healthcare Access and the Impact of Telehealth within the Veterans Health Administration</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2023-07-01</date><risdate>2023</risdate><volume>38</volume><issue>Suppl 3</issue><spage>805</spage><epage>813</epage><pages>805-813</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>Background
Travel is a major barrier to healthcare access for Veteran Affairs (VA) patients, and disproportionately affects rural Veterans (approximately one quarter of Veterans). The CHOICE/MISSION acts’ intent is to increase timeliness of care and decrease travel, although not clearly demonstrated. The impact on outcomes remains unclear. Increased community care increases VA costs and increases care fragmentation. Retaining Veterans within the VA is a high priority, and reduction of travel burdens will help achieve this goal. Sleep medicine is presented as a use case to quantify travel related barriers.
Objective
The Observed and Excess Travel Distances are proposed as two measures of healthcare access, allowing for quantification of healthcare delivery related to travel burden. A telehealth initiative that reduced travel burden is presented.
Design
Retrospective, observational, utilizing administrative data.
Subjects
VA patients with sleep related care between 2017 and 2021. In-person encounters: Office visits and polysomnograms; telehealth encounters: virtual visits and home sleep apnea tests (HSAT).
Main Measures
Observed distance: distance between Veteran’s home and treating VA facility. Excess distance: difference between where Veteran received care and nearest VA facility offering the service of interest. Avoided distance: distance between Veteran’s home and nearest VA facility offering in-person equivalent of telehealth service.
Key Results
In-person encounters peaked between 2018 and 2019, and have down trended since, while telehealth encounters have increased. During the 5-year period, Veterans traveled an excess 14.1 million miles, while 10.9 million miles of travel were avoided due to telehealth encounters, and 48.4 million miles were avoided due to HSAT devices.
Conclusions
Veterans often experience a substantial travel burden when seeking medical care. Observed and excess travel distances are valuable measures to quantify this major healthcare access barrier. These measures allow for assessment of novel healthcare approaches to improve Veteran healthcare access and identify specific regions that may benefit from additional resources.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>37340257</pmid><doi>10.1007/s11606-023-08125-3</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-5703-2957</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0884-8734 |
| ispartof | Journal of general internal medicine : JGIM, 2023-07, Vol.38 (Suppl 3), p.805-813 |
| issn | 0884-8734 1525-1497 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10356728 |
| source | MEDLINE; SpringerNature Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Apnea Community health care Health care Health services Health Services Accessibility Humans Internal Medicine Medicine Medicine & Public Health Original Research Patients Retrospective Studies Sleep Sleep disorders Telemedicine Travel Travel-Related Illness United States - epidemiology United States Department of Veterans Affairs Veterans Veterans Health |
| title | Travel Burden as a Measure of Healthcare Access and the Impact of Telehealth within the Veterans Health Administration |
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