Abstract
BackgroundThe impact of telemedicine on ambulatory care quality is a key question for policymakers as they navigate payment reform for remote care.ObjectiveTo evaluate whether utilizing telemedicine in the first 9 months of the COVID-19 pandemic impacted performance on a diabetes quality of care measure for patients at a large academic medical center. We hypothesized care quality would reduce less among telemedicine users.DesignQuasi-experimental design using binomial logistic regression. Covariates included age, gender, race, ethnicity, type of insurance, hierarchical condition category score, primary language at the individual level, and zip code–level income.ParticipantsAll adult patients younger than 75 years of age diagnosed with type 2 diabetes mellitus (N = 16,588) as of 3/19/2020 at a single academic health center.InterventionsCompletion of one or more telemedicine encounters with an institutional primary care physician or endocrinologist between 3/19/2020 and 12/19/2020.Main MeasuresThe components met in a five-item composite measure of diabetes quality of care, as of patients’ last clinical encounter. Items were (1) systolic blood pressure less than 140 mmHg, (2) hemoglobin A1c less than 8.0%, (3) using a statin and (4) aspirin, and (5) tobacco non-use.Key ResultsFrom the pre- to post-period, the probability of meeting any given component of the composite measure for patients only utilizing in-person care was 21% lower (OR, 95% CI 0.79; 0.76, 0.81) and for the telemedicine users 2% lower (OR 0.98; 0.85, 1.13). There was an increased likelihood of meeting any given component among telemedicine users compared to in-person care alone (OR 1.25; 1.08, 1.44).ConclusionsPatients with diabetes utilizing telemedicine performed similarly on a composite measure of diabetes care quality compared to before the pandemic. Those not utilizing telemedicine had reductions. Telemedicine use maintained quality of care for patients with diabetes during the first 9 months of the COVID-19 pandemic.
Highlights
The impact of telemedicine on ambulatory care quality is a key question for policymakers as they navigate payment reform for remote care
As in-person visits sharply declined, the proportion of ambulatory care delivered via telemedicine increased to peak at nearly half of all ambulatory encounters in June 2020.1 Subsequently, telemedicine encounters fell with the resumption of in-person care, but telemedicine visit volume persisted at nearly a quarter of total ambulatory encounters for the first 9 months of the pandemic
Patients with diabetes in a large academic medical center who used telemedicine achieved similar quality outcomes compared to before the pandemic; patients who utilized only in-person care saw a decline in the quality outcome ascertainment
Summary
The impact of telemedicine on ambulatory care quality is a key question for policymakers as they navigate payment reform for remote care. OBJECTIVE: To evaluate whether utilizing telemedicine in the first 9 months of the COVID-19 pandemic impacted performance on a diabetes quality of care measure for patients at a large academic medical center. As in-person visits sharply declined, the proportion of ambulatory care delivered via telemedicine (defined as both audio-only and audio-video encounters) increased to peak at nearly half of all ambulatory encounters in June 2020.1 Subsequently, telemedicine encounters fell with the resumption of in-person care, but telemedicine visit volume persisted at nearly a quarter of total ambulatory encounters for the first 9 months of the pandemic This “blend” of in-person and remote care in the ambulatory setting transformed office-based medical practice. Despite this evidence until the COVID-19-related PHE, there has not been broad, population-wide telemedicine utilization, and previous studies were subject to the generalizability issues inherent in smaller demonstrations
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