Abstract 14113: Impact of Clinician Telemedicine Use on Diagnostic Testing for Heart Failure Patients

Abstract

Introduction: Previous studies have reported decreased diagnostic testing with telemedicine visits early in the COVID-19 pandemic. The effect of telemedicine use on diagnostic testing for a panel of heart failure (HF) patients is unknown. We sought to use clinician-level variation in telemedicine use over time to determine the association of telemedicine care delivery with changes in diagnostic testing for HF patients. Methods: Patients with HF diagnostic codes seen at an academic cardiovascular center from May 2019 to Nov 2022 were included. Clinicians performing the majority of cardiology visits for at least 10 HF patients were identified. Early pandemic visits (March 2020-May 2020) were excluded. The remaining time was divided into 4 10-month periods with the first ending before the pandemic. We used a linear regression model with clinician and period fixed effects to estimate the association of the fraction of a clinician’s visits delivered by telemedicine in each period with the number of orders for Holter monitors, EKGs, transthoracic echocardiograms (TTEs), and laboratory tests per visit. Results: There were 6,420 patients seen by 45 clinicians. Clinician telemedicine fraction across periods ranged from 0 to 100 percent. Mean telemedicine fraction decreased from 55.4% to 34.6% from periods 2 to 4. A 25-percentage point increase in telemedicine use was associated with significantly fewer orders for EKGs (-0.078 orders/visit) and TTEs (-0.021 orders/visit), representing decreases of 33% and 13% relative to period 1 respectively. Higher telemedicine use was associated with non-significant decreases in orders for Holter monitors and laboratory tests (Table). Conclusions: Greater clinician telemedicine use was associated with decreased diagnostic testing orders per visit for HF patients. Further research is needed to characterize the value of these potentially avoided tests and understand the impact of telemedicine on the quality of care for HF patients.