Abstract
Telemedicine provides patients access to episodic and longitudinal care. Policy discussions surrounding future support for telemedicine require an understanding of factors associated with successful video visits. To assess patient and clinician factors associated with successful and with failed video visits. This was a quality improvement study of 137 846 scheduled video visits at a single academic health system in southeastern Wisconsin between March 1 and December 31, 2020, supplemented with patient experience survey data. Patient information was gathered using demographic information abstracted from the electronic health record and linked with block-level socioeconomic data from the US Census Bureau. Data on perceived clinician experience with technology was obtained using the survey. The primary outcome of interest was the successful completion of a scheduled video visit or the conversion of the video visit to a telephone-based service. Visit types and administrative data were used to categorize visits. Mixed-effects modeling with pseudo R2 values was performed to compare the relative associations of patient and clinician factors with video visit failures. In total, 75 947 patients and 1155 clinicians participated in 137 846 scheduled video encounters, 17 190 patients (23%) were 65 years or older, and 61 223 (81%) patients were of White race and ethnicity. Of the scheduled video encounters, 123 473 (90%) were successful, and 14 373 (10%) were converted to telephone services. A total of 16 776 patients (22%) completed a patient experience survey. Lower clinician comfort with technology (odds ratio [OR], 0.15; 95% CI, 0.08-0.28), advanced patient age (66-80 years: OR, 0.28; 95% CI, 0.26-0.30), lower patient socioeconomic status (including low high-speed internet availability) (OR, 0.85; 95% CI, 0.77-0.92), and patient racial and ethnic minority group status (Black or African American: OR, 0.75; 95% CI, 0.69-0.81) were associated with conversion to telephone visits. Patient characteristics accounted for systematic components for success; marginal pseudo R2 values decreased from 23% (95% CI, 21.1%-26.1%) to 7.8% (95% CI, 6.3%-9.4%) with exclusion of patient factors. As policy makers consider expanding telehealth coverage and hospital systems focus on investments, consideration of patient support, equity, and friction should guide decisions. In particular, this quality improvement study suggests that underserved patients may become disproportionately vulnerable by cuts in coverage for telephone-based services.
Highlights
Telemedicine has been practiced for decades, its necessity reached new heights during the COVID-19 pandemic
As policy makers consider expanding telehealth coverage and hospital systems focus on investments, consideration of patient support, equity, and friction should guide decisions. This quality improvement study suggests that underserved patients may become disproportionately vulnerable by cuts in coverage for telephone-based services
With shortages of personal protective equipment and uncertainty regarding viral transmission, with high viral transmission levels in several regions in the United States, health care shifted to virtual visits at a quick pace.[4]
Summary
Telemedicine has been practiced for decades, its necessity reached new heights during the COVID-19 pandemic Prior to this pandemic, direct-to-consumer telemedicine use was driven by a relatively small segment of the health care consumer population.[1,2,3] during the COVID-19 pandemic, the rapid expansion of telemedicine in 2020 was facilitated by legislative and executive changes during the public health emergency that removed the “originating site” provision and increased restriction of in-person visits. Patients and physicians reported difficulties with platforms, accessing visits, and quality connections.[6] These friction points are more likely to challenge less socioeconomically advantaged patients, which may contribute to health disparities.[9] Understanding and exploring the difficulties that arose during the public health emergency is vital to address ongoing accessibility problems and provide adequate support for a sustainable medium of health care delivery in the future
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