Impact of Telehealth on Health Disparities Associated With Travel Time to Hospital for Patients With Recurrent Admissions: 4-Year Panel Data Analysis

Abstract

BackgroundGeographic, demographic, and socioeconomic differences in health outcomes persist despite the global focus on these issues by health organizations. Barriers to accessing care contribute significantly to these health disparities. Among these barriers, those related to travel time—the time required for patients to travel from their residences to health facilities—remain understudied compared with others. ObjectiveThis study aimed to explore the impact of telehealth in addressing health disparities associated with travel time to hospitals for patients with recurrent hospital admissions. It specifically examined the role of telehealth in reducing in-hospital length of stay (LOS) for patients living farther from the hospital. MethodsWe sourced the data from 4 datasets, and our final effective sample consisted of 1,600,699 admissions from 536,182 patients from 63 hospitals in New York and Florida in the United States from 2012 to 2015. We applied fixed-effect models to examine the direct effects and the interaction between telehealth and patients’ travel time to hospitals on LOS. We further conducted a series of robustness checks to validate our main models and performed post hoc analyses to explore the different effects of telehealth across various patient groups. ResultsOur summary statistics show that, on average, 22.08% (353,396/1,600,699) of patients were admitted to a hospital with telehealth adopted, with an average LOS of 5.57 (SD 5.06) days and an average travel time of about 16.89 (SD 13.32) minutes. We found that telehealth adoption is associated with a reduced LOS (P<.001) and this effect is especially pronounced as the patients’ drive time to the hospital increases. Specifically, the coefficient for drive time is –0.0079 (P<.001), indicating that for every additional minute of driving time, there is a decrease of 0.0079 days (approximately 11 minutes) in the expected LOS. We also found that telehealth adoption has a larger impact on patients frequently needing health services, patients living in high internet coverage areas, and patients who have high virtualization potential diseases. ConclusionsOur findings suggest that telehealth adoption can mitigate certain health disparities for patients living farther from hospitals. This study provides key insights for health care practitioners and policy makers on telehealth’s role in addressing distance-related disparities and planning health care resources. It also has practical implications for hospitals in resource-limited countries that are in the early stages of implementing telehealth.