ABSTRACT
Background: The SARS-CoV2 pandemic has increased interest in telemedicine use among hepatology providers On 3/17/2020, all patient visits at VA Greater Los Angeles (GLA) Healthcare System were converted from face-to-face to telephone or video visits in our hepatology clinic As part of a quality improvement effort, we evaluated our ability to reach and provide consultative care to GLA Veterans with cirrhosis during this time Methods: We examined outpatient encounters from 1/1/2020-5/31/2020 in our two weekly hepatology specialty clinics Validated ICD- 10 codes and manual chart review were used to confirm a diagnosis of cirrhosis We abstracted demographics, encounter characteristics (type, successful contact), clinical characteristics, and documented care provided during encounters (health care maintenance counseling;medication refills or changes;ordering of bloodwork, imaging, or endoscopy;and referrals). We classified a patient as having been 'reached' if we were able to complete at least one encounter with them over the study period We compared, with t-tests and Chi-squared tests, our ability to reach patients, patient characteristics, and care delivered before and after 3/17/2020, using STATA 14 2 Results: We identified 145 Veterans with cirrhosis scheduled over 322 encounters Most Veterans were male (98%), with a mean age of 68 (SD=9 9) years;40% were White Thirty six percent of Veterans had decompensated cirrhosis and 21% had hepatocellular carcinoma Before 3/17/2020, 93/104 (89%) of Veterans with scheduled encounters were successfully reached, of which all were in-person consultations Among Veterans with scheduled encounters March 17th, 2020 and after, 83/89 (93%), were reached, of which 87% used telemedicine (84% phone, 3% video) There were no major demographic differences among Veterans reached before and after telehealth implementation (see Table) Rates of health care maintenance counseling, medication changes or refills, as well as ordering of bloodwork, imaging, endoscopy, and new referrals, were similar Veterans reached post-telemedicine adoption had a significantly higher number of encounters with our clinic (1 35 vs 1 07, p=0 01) Conclusion: Adoption of telemedicine practices during the SARS-CoV2 pandemic led to similar rates of care being provided to Veterans pre-pandemic, though over more encounters. We observed no significant disparities in age, gender, or race/ethnicity in reaching Veterans using thispractice However, use of video visits was low These results suggest that telemedicine is a feasible strategy to manage patients with cirrhosis in our clinic However, more information is needed on the reasons for low uptake of video visits, as well as Veteran experiences, adherence, and outcomes with telemedicine-delivered cirrhosis care.