51.23 VISIT COMPLETION RATES AND MOBILITY GONE VIRTUAL: HOW A LARGE COMMUNITY-BASED PRAGMATIC CLINICAL TRIAL IMPROVED VISIT COMPLETION DURING THE COVID-19 PANDEMIC

ABSTRACT

Objectives: The objective of this presentation is to examine how visit completion rates were affected by the transformation of a large community-based pragmatic clinical trial (entitled Metformin for overweight and OBese chILdren with bIpolar spectrum disorders Treated with second-generation antipsYchotics [MOBILITY]) to remote follow-up visits with the use of telepsychiatry and virtual research methodology in light of a pandemic. Methods: MOBILITY is a Patient-Centered Outcome Research Institute (PCORI)-funded, large, randomized pragmatic clinical trial designed to examine the effectiveness of metformin and healthy lifestyle instruction vs healthy lifestyle instruction alone on BMI and other metabolic and clinically useful parameters. We examined visit completion rates of patients due for a study visit on April 1, 2020 performed in the remote care visit window (April 1, 2020 to May 31, 2020) by visit type (month 6, month 24, other visit) and institution type (community vs academic) to in-person visits from the coinciding preceding enrollment period (April 1, 2019 to May 31, 2019). Results: Of the total 603 patients in-window on April 1, 2020 for a visit, 180 patients (29.9%) had an in-window remote visit. Of the total 620 patients in-window on April 1, 2019 for a visit, 159 patients (25.6%) had an in-window in-person visit. There were no significant time x type interaction effects for visit type (p = 0.37) or institution type (p = 0.26). However, there were significant main effects for visit type and institution type, with higher month-24 in-window visits for remote visits vs in-person visits (2020 = 14.9% vs 2019 = 9.4%;p < 0.01) and higher overall visits in academic vs nonacademic centers (2020 = 34.4% vs 2019 = 27.7%). Conclusions: Overall visit completion rates comparing the pre-COVID-19 enrollment period in 2019 to the same period in 2020 did not show significant changes in visit completion rates. Despite the shift to remote visits, visit completion rates for this large, pragmatic study that are linked to clinical care visits did not suffer. However, month-24 visit completion rates were significantly improved. Academic institutions were able to hold or improve visit completion rates more effectively than community-based ones. Making virtual visits available in clinical effectiveness research may be beneficial by decreasing patient and caregiver burden, improving data quality, and reducing cost, although this may be more easily accomplished in academic centers. R, BRD, TVM