Visit and Between-Visit Interaction Frequency Before and After COVID-19 Telehealth Implementation
Authors' conclusion
In this study, pre-PHE growth in overall patient-clinician encounters persisted after PHE-related telehealth implementation, driven in both periods by between-visit interactions. Differential utilization based on patient characteristics was observed, which may indicate disparities. The implications for health care team workload and patient outcomes are unknown, particularly regarding between-visit interactions. Therefore, to comprehensively understand care utilization for patients with chronic diseases, research should expand beyond billed visits.
Study context
- Population
- Adults with diabetes receiving primary care at urban academic (UCSF) and safety-net (SFHN) systems; encounters April 2019 to March 2021
- Participants
- 15,148 adults
- Exposure
- Hybrid-PHE vs pre-PHE and strict shelter-in-place periods of telehealth implementation
- UCSFn = 4,976
- SFHNn = 8,975
- Outcome
- Rates of change in monthly mean number of total encounters, visits with any health care team member, visits with billing clinicians, and between-visit interactions
- Follow-up
- Pre-PHE (April 2019–March 2020), strict shelter-in-place (April–June 2020), hybrid-PHE (July 2020–March 2021)
Methodological detailsinterrupted time-series analysis
- Interrupted time-series analysis
Main finding
As reported in the abstract
UCSF
2.3%
95% CI 1.6%–2.9% · per patient/mo
SFHN
1.8%
95% CI 1.3%–2.2% · per patient/mo
- Between-visit interactions growth, UCSF
- 3.1% (per patient/mo; 95% CI, 2.3%-3.8%)
- Between-visit interactions growth, SFHN
- 2.9% (per patient/mo; 95% CI, 2.3%-3.4%)
Observational data: associations, not effects.
Further findings
Asian vs White
Monthly mean between-visit interactions by race, SFHN · hybrid-PHE period · fewer with Asian
P < 0.001
Chinese-speaking vs English-speaking
Monthly mean between-visit interactions by language, SFHN · hybrid-PHE period · fewer with Chinese-speaking
P = 0.03
Original publication
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