Journal article
Comparing Federal Communications Commission and Microsoft Estimates of Broadband Access for Mental Health Video Telemedicine Among Veterans: Retrospective Cohort Study
Journal of medical Internet research, Vol.26, e47100
08/08/2024
DOI: 10.2196/47100
PMCID: PMC11342002
PMID: 39116440
Abstract
The COVID-19 pandemic highlighted the importance of telemedicine in health care. However, video telemedicine requires adequate broadband internet speeds. As video-based telemedicine grows, variations in broadband access must be accurately measured and characterized.BACKGROUNDThe COVID-19 pandemic highlighted the importance of telemedicine in health care. However, video telemedicine requires adequate broadband internet speeds. As video-based telemedicine grows, variations in broadband access must be accurately measured and characterized.This study aims to compare the Federal Communications Commission (FCC) and Microsoft US broadband use data sources to measure county-level broadband access among veterans receiving mental health care from the Veterans Health Administration (VHA).OBJECTIVEThis study aims to compare the Federal Communications Commission (FCC) and Microsoft US broadband use data sources to measure county-level broadband access among veterans receiving mental health care from the Veterans Health Administration (VHA).Retrospective observational cohort study using administrative data to identify mental health visits from January 1, 2019, to December 31, 2020, among 1161 VHA mental health clinics. The exposure is county-level broadband percentages calculated as the percentage of the county population with access to adequate broadband speeds (ie, download >25 megabits per second) as measured by the FCC and Microsoft. All veterans receiving VHA mental health services during the study period were included and categorized based on their use of video mental health visits. Broadband access was compared between and within data sources, stratified by video versus no video telemedicine use.METHODSRetrospective observational cohort study using administrative data to identify mental health visits from January 1, 2019, to December 31, 2020, among 1161 VHA mental health clinics. The exposure is county-level broadband percentages calculated as the percentage of the county population with access to adequate broadband speeds (ie, download >25 megabits per second) as measured by the FCC and Microsoft. All veterans receiving VHA mental health services during the study period were included and categorized based on their use of video mental health visits. Broadband access was compared between and within data sources, stratified by video versus no video telemedicine use.Over the 2-year study period, 1,474,024 veterans with VHA mental health visits were identified. Average broadband percentages varied by source (FCC mean 91.3%, SD 12.5% vs Microsoft mean 48.2%, SD 18.1%; P<.001). Within each data source, broadband percentages generally increased from 2019 to 2020. Adjusted regression analyses estimated the change after pandemic onset versus before the pandemic in quarterly county-based mental health visit counts at prespecified broadband percentages. Using FCC model estimates, given all other covariates are constant and assuming an FCC percentage set at 70%, the incidence rate ratio (IRR) of county-level quarterly mental video visits during the COVID-19 pandemic was 6.81 times (95% CI 6.49-7.13) the rate before the pandemic. In comparison, the model using Microsoft data exhibited a stronger association (IRR 7.28; 95% CI 6.78-7.81). This relationship held across all broadband access levels assessed.RESULTSOver the 2-year study period, 1,474,024 veterans with VHA mental health visits were identified. Average broadband percentages varied by source (FCC mean 91.3%, SD 12.5% vs Microsoft mean 48.2%, SD 18.1%; P<.001). Within each data source, broadband percentages generally increased from 2019 to 2020. Adjusted regression analyses estimated the change after pandemic onset versus before the pandemic in quarterly county-based mental health visit counts at prespecified broadband percentages. Using FCC model estimates, given all other covariates are constant and assuming an FCC percentage set at 70%, the incidence rate ratio (IRR) of county-level quarterly mental video visits during the COVID-19 pandemic was 6.81 times (95% CI 6.49-7.13) the rate before the pandemic. In comparison, the model using Microsoft data exhibited a stronger association (IRR 7.28; 95% CI 6.78-7.81). This relationship held across all broadband access levels assessed.This study found FCC broadband data estimated higher and less variable county-level broadband percentages compared to those estimated using Microsoft data. Regardless of the data source, veterans without mental health video visits lived in counties with lower broadband access, highlighting the need for accurate broadband speeds to prioritize infrastructure and intervention development based on the greatest community-level impacts. Future work should link broadband access to differences in clinical outcomes.CONCLUSIONSThis study found FCC broadband data estimated higher and less variable county-level broadband percentages compared to those estimated using Microsoft data. Regardless of the data source, veterans without mental health video visits lived in counties with lower broadband access, highlighting the need for accurate broadband speeds to prioritize infrastructure and intervention development based on the greatest community-level impacts. Future work should link broadband access to differences in clinical outcomes.
Details
- Title: Subtitle
- Comparing Federal Communications Commission and Microsoft Estimates of Broadband Access for Mental Health Video Telemedicine Among Veterans: Retrospective Cohort Study
- Creators
- Amy M J O'Shea - University of Iowa, General Internal MedicineKailey Mulligan - University of IowaKnute D Carter - University of IowaBjarni Haraldsson - Iowa City VA Health Care SystemCharlie M Wray - University of California, San FranciscoAriana Shahnazi - Iowa City VA Health Care SystemPeter J Kaboli - Iowa City VA Health Care System
- Resource Type
- Journal article
- Publication Details
- Journal of medical Internet research, Vol.26, e47100
- Publisher
- JMIR PUBLICATIONS, INC
- DOI
- 10.2196/47100
- PMID
- 39116440
- PMCID
- PMC11342002
- ISSN
- 1438-8871
- eISSN
- 1438-8871
- Grant note
This material is based upon work supported (or supported in part) by the Department of Veterans Affairs (VA) , Veterans HealthAdministration (VHA) , VA Office of Connected Care (COR 20-199-05) , and the Office of Research and Development, HealthServices Research and Development (HSR&D) Service through the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center (CIN 13-412) . The funders had no role in the design and conduct of the study; collection, management, analysis,and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript forpublication. The data sets generated and analyzed are not publicly available due to VHA privacy and confidentiality requirementsbut are available to VHA researchers from the corresponding author on reasonable request. This work was designated nonresearchsince it was carried out as a quality improvement evaluation under the terms of a signed attestation of nonresearch from the VHAOffice of Connected Care. This VHA documentation ensures that work not carried out under a human subjects protocol is partof institutionally sanctioned quality improvement activities. The views expressed in this paper are those of the authors and donot necessarily represent the views of the Department of VA or the US government.
- Language
- English
- Date published
- 08/08/2024
- Academic Unit
- Epidemiology; Biostatistics; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984696702502771
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