Role of Telehealth Use in Chronic Care Management and Disparity Reduction Among the Aging Population.

Abstract

Introduction: To examine telehealth use in chronic care management and disparity reduction among the aging population. Methods: This longitudinal cohort study compared the changes in chronic care quality measures among patients with and without telehealth visits during the COVID-19 pandemic relative to patients in the previous years and by patient sociodemographic subgroup. Participants were Medicare fee-for-service beneficiaries 65 years or older from an Accountable Care Organization in the Midwest United States. Three utilization-based measures included having 2+ A1C tests, breast cancer screening, and depression screening. Three outcome-based measures included A1C control, blood pressure control, and depression diagnosis. Results: During the study period, the pandemic cohort experienced 5-17 percentage points' decrease in utilization-based measures (e.g., 2+ A1C tests 63.9% vs. 51.1%; OR [95% confidence intervals] = 0.35 [0.34-0.36]) from baseline relative to the control cohort. The outcome-based measures also significantly decreased but at smaller magnitudes (3-5 percentage points). About 51.5% patients had at least one telehealth visit. The utilization-based measures for these patients were significantly higher than those without any telehealth visit (e.g., 2+ A1C 57.1% vs. 51.1%, p < 0.01). However, the outcome-based measures were comparable. Patients from historically underserved groups had a larger decline in health care outcomes than their counterparts. Among patient with at least one telehealth visit, these disparities were no longer significant. Discussions: Telehealth was associated with less negative impact of the pandemic and better performance in chronic care management, but more for utilization-based measures and less for outcome-based measures. Telehealth was also associated with less disparities in care outcomes.