Associations With Virtual Visit Use Among Patients Receiving Radiation Therapy

ABSTRACT

To test for associations in virtual visit use among radiation oncology patients. Using the electronic medical record, we extracted encounter data and corresponding patient information the 6 months prior to and 6 months of COVID-enabled virtual visits (10/1/2019-3/22/2020 versus 3/23/2020-9/1/2020) at a large tertiary cancer center. Encounters during COVID were categorized as in-person or virtual visits. Descriptive and univariate analysis was conducted on the characteristics of patient populations during the pre-COVID period to establish baseline demographics and compare to the during COVID period. Examined demographic variables included race, ethnicity, age, sex, marital status, preferred language, insurance status and tumor characteristics including disease site. Univariate and multivariable (MVA) logistic regression examined patient demographic and disease characteristics associated with virtual visit use. We analyzed 4,974 total encounters, (2,287 pre-COVID and 2,687 during COVID), among 3,960 total patients. All (100%) pre-COVID encounters were in-person whereas during COVID, 21% of encounters were via virtual visits. Overall, there were no differences identified in pre- versus during COVID patient characteristics. However, we found significant differences in patient characteristics for in-person versus virtual encounters during COVID. On MVA, virtual visit use was less common among patients of minority race (white n = 321 versus black n = 100 and other n = 35, OR 0.73, 95% CI 0.57-0.94, P = 0.014) and not married (OR 0.78, 95% CI 0.61-1.00, P = 0.048). Patients diagnosed with head and neck (OR 0.64, 95% CI 0.42-0.96, P = 0.030), breast (OR 0.35, 95% CI 0.20-0.60, P = < 0.001), GI/abdominal (OR 0.31, 95% CI 0.16-0.62, P = 0.001) or hematologic malignancy (OR 0.18, 95% CI 0.04-0.84, P = 0.029), were less likely to use virtual visits relative to patients with genitourinary malignancy. While the patient populations were similar prior to and during COVID, when controlling for available variables, we found significant differences in virtual visit use by patient characteristics, including race and marital status as well as disease characteristics. Further study is needed to elucidate additional factors that underlie these differences in virtual visit utilization;health equity should be considered when implementing virtual visits. Our findings raise the hypothesis that vulnerable patient groups may benefit from additional interventions and outreach to enable equitable access. [ABSTRACT FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)