ABSTRACT
INTRODUCTION: Unplanned readmissions can be avoided by standardizing and improving the coordination of care after discharge. Telemedicine has been increasingly utilized; however, the quality of this care has not been well studied. Standardized measures can provide an objective comparison of care quality. The purpose of our study was to compare quality performance transitions of care management in the office vs telemedicine. METHODS: The Epic SlicerDicer tool was used to compare the percentage of encounters that were completed via telemedicine (video visits); or via in-person for comparison, Chi-squared tests were used. RESULTS: A total of 13,891 patients met the inclusion criteria during the study time frame. There were 12,846 patients in the office and 1,048 in the telemedicine cohort. The office readmission rate was 11.9% with 1,533 patients out of 12,846 compared with telemedicine with the rate of readmission at 12.1% with 126 patients out of 1,045 patients. The P-value for the Chi-squared test between the prepandemic and study time frame was 0.15 and 0.95, respectively. Demographic comparability was seen. DISCUSSION: Our study found a comparable readmission rate between patients seen via in-office and telemedicine for Transitions of Care Management (TCM) encounters. The findings of this study support the growing body of evidence that telemedicine augments quality performance while reducing cost and improving access without negatively impacting HEDIS performance in health care systems. CONCLUSION: Telemedicine poses little threat of negatively impacting HEDIS performance and might be as effective as posthospitalization traditional office care transitions of care management.
Subject(s)
Patient Discharge , Patient Readmission , Telemedicine , Humans , Patient Readmission/statistics & numerical data , Telemedicine/statistics & numerical data , Female , Male , Patient Discharge/statistics & numerical data , Middle Aged , Aged , Adult , Aftercare/statistics & numerical data , Aftercare/methods , Quality of Health Care/statistics & numerical data , Continuity of Patient Care/organization & administration , Continuity of Patient Care/statistics & numerical dataABSTRACT
Importance: Despite its rapid adoption during the COVID-19 pandemic, it is unknown how telemedicine augmentation of in-person office visits has affected quality of patient care. Objective: To examine whether quality of care among patients exposed to telemedicine differs from patients with only in-person office-based care. Design, Setting, and Participants: In this retrospective cohort study, standardized quality measures were compared between patients with office-only (in-person) visits vs telemedicine visits from March 1, 2020, to November 30, 2021, across more than 200 outpatient care sites in Pennsylvania and Maryland. Exposures: Patients completing telemedicine (video) visits. Main Outcomes and Measures: χ2 tests determined statistically significant differences in Health Care Effectiveness Data and Information Set (HEDIS) quality performance measures between office-only and telemedicine-exposed groups. Multivariable logistic regression controlled for sociodemographic factors and comorbidities. Results: The study included 526â¯874 patients (409â¯732 office-only; 117â¯142 telemedicine exposed) with a comparable distribution of sex (196â¯285 [49.7%] and 74â¯878 [63.9%] women), predominance of non-Hispanic (348â¯127 [85.0%] and 105â¯408 [90.0%]) and White individuals (334â¯215 [81.6%] and 100â¯586 [85.9%]), aged 18 to 65 years (239â¯938 [58.6%] and 91â¯100 [77.8%]), with low overall health risk scores (373â¯176 [91.1%] and 100â¯076 [85.4%]) and commercial (227â¯259 [55.5%] and 81â¯552 [69.6%]) or Medicare or Medicaid (176â¯671 [43.1%] and 52â¯513 [44.8%]) insurance. For medication-based measures, patients with office-only visits had better performance, but only 3 of 5 measures had significant differences: patients with cardiovascular disease (CVD) receiving antiplatelets (absolute percentage difference [APD], 6.71%; 95% CI, 5.45%-7.98%; P < .001), patients with CVD receiving statins (APD, 1.79%; 95% CI, 0.88%-2.71%; P = .001), and avoiding antibiotics for patients with upper respiratory infections (APD, 2.05%; 95% CI, 1.17%-2.96%; P < .001); there were insignificant differences for patients with heart failure receiving ß-blockers and those with diabetes receiving statins. For all 4 testing-based measures, patients with telemedicine exposure had significantly better performance differences: patients with CVD with lipid panels (APD, 7.04%; 95% CI, 5.95%-8.10%; P < .001), patients with diabetes with hemoglobin A1c testing (APD, 5.14%; 95% CI, 4.25%-6.01%; P < .001), patients with diabetes with nephropathy testing (APD, 9.28%; 95% CI, 8.22%-10.32%; P < .001), and blood pressure control (APD, 3.55%; 95% CI, 3.25%-3.85%; P < .001); this was also true for all 7 counseling-based measures: cervical cancer screening (APD, 12.33%; 95% CI, 11.80%-12.85%; P < .001), breast cancer screening (APD, 16.90%; 95% CI, 16.07%-17.71%; P < .001), colon cancer screening (APD, 8.20%; 95% CI, 7.65%-8.75%; P < .001), tobacco counseling and intervention (APD, 12.67%; 95% CI, 11.84%-13.50%; P < .001), influenza vaccination (APD, 9.76%; 95% CI, 9.47%-10.05%; P < .001), pneumococcal vaccination (APD, 5.41%; 95% CI, 4.85%-6.00%; P < .001), and depression screening (APD, 4.85%; 95% CI, 4.66%-5.04%; P < .001). Conclusions and Relevance: In this cohort study of patients with telemedicine exposure, there was a largely favorable association with quality of primary care. This supports telemedicine's value potential for augmenting care capacity, especially in chronic disease management and preventive care. This study also identifies a need for understanding relationships between the optimal blend of telemedicine and in-office care.
Subject(s)
COVID-19 , Cardiovascular Diseases , Delivery of Health Care, Integrated , Diabetes Mellitus , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Telemedicine , Uterine Cervical Neoplasms , Aged , Anti-Bacterial Agents , COVID-19/epidemiology , Cohort Studies , Early Detection of Cancer , Female , Glycated Hemoglobin , Humans , Lipids , Male , Medicare , Pandemics , Primary Health Care , Retrospective Studies , United StatesABSTRACT
A retrospective chart review was carried out in children (neonates to 18 years) who underwent acute surgical abdominal exploration during 2012-2016 at the Aga Khan University Hospital, Karachi, to evaluate the postoperative surgical site infection rates in emergency paediatric abdominal surgery. Incidence of surgical site infection (SSI) was estimated. P-value was calculated, chisquare and non-parametric tests were performed by comparing pre-surgical and post-surgical procedure pathogen occurrence and pre-procedure wound status. Pathogen occurrence related to time-trend of 98 paediatric patients who underwent emergency abdominal surgery was plotted. Of the 94 who were discharged in stable condition, it was found that there was no significant difference between pre- and postsurgical pathogens. Escherichia coli (n=10) was found to be the most common pathogen. Contaminated wounds were associated with higher SSI (p=0.036, OR 1.95 95% CI 0.7-5.4). The study found that pre-surgery wound status could be an indicator for risk of SSI in a post-operative scenario.