ABSTRACT
Background/Introduction: Amidst the COVID-19 pandemic, the sudden demand for virtual medical visits drove the drastic expansion of telemedicine across all medical specialties. Current literature demonstrates limited knowledge on the impact of telehealth on appointment adherence particularly in preoperative anesthesia evaluations. We hypothesized that there would be increased completion of preoperative anesthesia appointments in patients who received telemedicine visits. Methods: We performed a retrospective cohort study of adult patients at UCLA who received preoperative anesthesia evaluations by telemedicine or in-person within the Department of Anesthesiology and Perioperative Medicine from January to September 2021 and assessed appointment adherence. The primary outcome was incidence of appointment completion. The secondary outcomes included appointment no show and cancellations. Patient demographic characteristics including sex, age, ASA physical status class, race, ethnicity, primary language, interpreter service requested, patient travel distance to clinic, and insurance payor were also evaluated. Demographic characteristics, notably race and ethnicity, are presented as captured in the electronic health record and we recognize its limitations and inaccuracies in illustrating how people identify. Patient reported reasons for cancellations were also reviewed and categorized into thematic groups by two physicians. Statistical comparison was performed using independent samples t test, Pearson's chi-square, and Fischer's exact test. Results: Of 1332 patients included in this study, 956 patients received telehealth visits while 376 patients received in-person preoperative anesthesia evaluations. Compared to the in-person group, the telemedicine group had more appointment completions (81.38% vs 76.60%, p = 0.0493). There were fewer cancellations (12.55% vs 19.41%, p = 0.0029) and no statistical difference in appointment no-shows (6.07% vs 3.99%, p = 0.1337) in the telemedicine group (Figure 1). Compared to the in-person group, patients who received telemedicine evaluations were younger (55.81 ± 18.38 vs 65.97 ± 15.19, p < 0.001), less likely American Indian and Alaska Native (0.31% vs 1.60%, p = 0.0102), more likely of Hispanic or Latino ethnicity (16.63% vs 12.23%, p = 0.0453), required less interpreter services (4.18% vs 9.31%, p = 0.0003), had more private insurance coverage (53.45% vs 37.50%, p < 0.0001) and less Medicare coverage (37.03% vs 50.53%, p < 0.0001). Main reasons for cancellation included patient request, surgery rescheduled/cancelled/already completed, and change in method of appointment. Conclusions: In 2021, preoperative anesthesia evaluation completion was greater in patients who received telemedicine appointments compared to those who received in-person evaluations at UCLA. We also demonstrate potential shortcomings of telemedicine in serving patients who are older, require interpreter services, or are non-privately insured. Knowledge of these factors can provide feedback to improve access and equity to telehealth for patients from all backgrounds, particularly during the COVID pandemic as virtual evaluations increase. (Table Presented).
ABSTRACT
Objective: We wanted to see how outpatient neurology clinics at UCLA changed following COVID-19. Background: The COVID-19 pandemic forced rapid adoption of telemedicine for care of neurology patients. This study describes the structure and implementation of telemedicine-based outpatient neurology clinics at UCLA Medical Center, before and after the California COVID-19 "Safer at Home" order, with a novel method to determine patient cost savings. We also present patient and provider satisfaction. Design/Methods: This was a retrospective, non-randomized, case series of telemedicine-based neurological management in an urban academic medical center from October 2018 to June 2020. Estimated roundtrip travel time, travel distance, and total travel cost are reported. Time-based opportunity savings were estimated using publicly available Internal Revenue Service statistics of income tax data to approximate hourly earnings by ZIP code. Patient satisfaction surveys were automatically sent to each patient following every video visit encounter. Results: We conducted 9,189 telemedicine video visits by 7,194 patients seeking neurological care. Telemedicine patients avoided a median roundtrip driving distance of 33 miles and saved a median roundtrip travel time of 75 minutes. With in the sample, median hourly earnings were $27/hr. Patients saved a median of $18 on fuel and parking, and $36 in time-based opportunity savings, for $54 median total savings per telemedicine visit. In 1,000 surveys, 86% of patients were satisfied with the video visit experience. Satisfaction of 37 providers was surveyed, with 29 responses (78.4%) supporting effectiveness of video visits as meeting expectations. Conclusions: Telemedicine offers travel and time savings for neurology patients. Successful implementation of telemedicine-based neurology clinics in an academic metropolitan medical center achieved high patient and provider satisfaction and cost savings. Future studies should explore transitions into hybrid approaches that combine in-person visits with telemedicine.