Impacts of Telehealth Adoption on the Quality of Care for Individuals With Serious Mental Illness: Retrospective Observational Analysis of Veterans Affairs Administrative Data

Abstract

Abstract BackgroundTelehealth implementation can be challenging for persons with serious mental illness (SMI), which may impact their quality of care and health outcomes. The literature on telehealth’s impacts on SMI care outcomes is mixed, necessitating further investigation. ObjectiveWe examined the impacts of facility-level telehealth adoption on quality of care metrics over time among patients with SMI. MethodsWe analyzed Veterans Affairs (VA) administrative data across 138 facilities from January 2021 to December 2022. We performed longitudinal mixed-effects regressions to identify the relationships between the proportion of facility-level telehealth visits and SMI specialty care quality metrics: engagement with primary care; access and continuity of care across a range of mental health services including psychotherapy or psychosocial rehabilitation, SMI-specific intensive outpatient programs, and intensive case management; and continuity of mental health care after a high-risk event (eg, suicide attempt). ResultsFacilities with a higher proportion of telehealth visits had reduced access and continuity of physical and mental health care for patients with SMI (PzPzPzPzPzPzPzP ConclusionsAlthough telehealth helped preserve health care access during the pandemic, telehealth may have tradeoffs with regard to quality of care for some individuals with SMI. These data suggest that engagement strategies used by SMI-specific intensive case management may have preserved quality and could benefit other settings. Strategies that enhance telehealth implementation—selected through a health equity lens—may improve quality of care among patients with SMI.