Telemedicine For Veterans in the Setting of the COVID-19 Pandemic: Lessons Learned From VISN 8'S Clinical Contact Center (A Virtual Urgent Care) in Avoiding Emergency Department Visits

ABSTRACT

Study Objective: The onset of the COVID-19 pandemic forced the health care industry to consider telemedicine as the primary modality for health care with focus on value and ease for providers and patients alike to achieve outcomes similar to face-to-face primary care (PC), urgent care (UC), and emergency department (ED) visits. It remained unclear if telemedicine visits actually achieved first contact resolution (FCR), fully meeting the patients’ needs through their virtual care experience. At a time when Florida ranked #3 in its COVID-19 census, Veterans needed access to timely care to answer their concerns and questions. This is even more important as Veterans tend to have multiple comorbidities, translating into increased risk of morbidity and mortality with COVID-19. VISN 8, a region of the U.S. Department of Veteran Affairs (VA) that covers most of Florida, South Georgia, Puerto Rico, and the U.S. Virgin Islands, established a Clinical Contact Center (CCC) in July 2019. The CCC is a 24/7 virtual urgent care organization providing episodic care via telephone and video with physicians and nurse practitioners who work 7 days a week from 7A to 1130P. A physician was available overnight for COVID-19-related concerns. This study examined the change in CCC workload as a result of the COVID-19 pandemic and assessed first contact resolution (FCR) for patients with COVID-19 related chief complaints. Methods: This was a retrospective study centered around March 11, 2020, when the World Health Organization (WHO) declared a pandemic. This analysis included a sample size of 6,660 patient episodes between March - August 2020. Our outcome variable of interest was FCR. We constructed a binary disposition variable of “stay at home” or “other” which included presentation to the ED or PC. Data collected included patient age, sex, race/ethnicity, COVID-19-related chief complaints, and visit modality (phone versus video). We used a logistic regression to examine factors affecting the probability that patients remained at home. A VA IRB determined that the study was exempt from review. Results: Figure 1 displays the increase in CCC workload during the pandemic starting in March 2020 with a sustained ability to achieve FCR. During the pandemic, patients with suspected COVID-19 were 2.75 times more likely to stay at home than patients calling with non-COVID-19 related chief complaints. This suggests that telemedicine offers significant public health value to patients who are not presenting to the ED or for PC visits potentially exposing themselves and others to the spread of the virus. The control variables of sex and visit modality were found to not be statistically significant. Conclusion: This study established the value of telemedicine in a pandemic with FCR and avoidance of public spaces that could potentially lead to a COVID-19 infection. The service provided by the CCC was invaluable to Veterans as they sought out timely care. [Formula presented]