A Brief Retrospective Review of Medical Records Comparing Outcomes for Inpatients Treated via Telehealth Versus In-Person Protocols: Is Telehealth Equally Effective as In-Person Visits for Treating Neutropenic Fever, Bacterial Pneumonia, and Infected Bacterial Wounds?

Abstract

The incidence of infectious diseases in the United States has been increasing since 1980. Re-emergent conditions, multidrug-resistant bacteria, newly identified infections, and bioterrorism have prompted public health surveillance and control initiatives, including the use of telehealth technology. Infectious diseases, such as West Nile Virus, pose a particular threat to rural areas, where access to infectious disease specialists (IDS) is limited. Initial, in-patient IDS consultations are reimbursed by Centers for Medicare & Medicaid Services for in-person and for telehealth services. Follow-up consultation and subsequent care visits are reimbursed when delivered via in-person care, but not reimbursed when delivered via telehealth. The purpose of this study is to investigate the efficacy of telehealth technology (interactive videoconferencing) in providing timely, efficient, and prudent infectious disease care for rural patients. We conducted a retrospective, comparative review of medical records (n = 107) from inpatients at a metropolitan hospital (n = 59) in a rural state who received in-person IDS treatment, with records from inpatients at nonmetropolitan, rural, and frontier hospitals (n = 48) in the same state who received telehealth IDS treatment. Outcome measures, including number of days hospitalized, number of days receiving intravenous antibiotic, survival, and transfer to another hospital, were compared for three commonly occurring infectious diseases: neutropenic fever, bacterial pneumonia, or bacterial wound infection. Patients treated via telehealth had fewer days on antibiotics and fewer days hospitalized than patients treated via in-person intervention. Survival rates did not differ significantly between groups, but were lower for telehealth patients. Fewer in-person patients required transfer to hospitals offering a higher level of care. Ninety percent of telehealth patients were able to remain at their local hospital for treatment. Results were statistically significant only for selected outcomes and conditions. IDS treatment for the conditions studied is equally effective when delivered via telehealth as when delivered via in-person methods.

Rapid Implementation of an Inpatient Telehealth Program during the COVID-19 Pandemic

“…8 For hospitalized patients there are numerous reports of using telehealth for rapid evaluation for intensive care and subspecialty consults such as dermatology, infectious diseases, and psychiatry, where a thorough chart review, history, and visual exam may provide consultants with sufficient information to make clinical recommendations. [9][10][11][12][13][14][15][16][17][18] Telehealth has also been used to engage patients and families in their care during and after hospitalization. [19][20][21] One major limitation to the widespread adoption of telehealth initiatives has been the lack of payment models 22 however, in response to the COVID-19 pandemic both federal and state governments have loosened restrictions on privacy and billing for telehealth visits in an effort to allow health care providers to continue to care for patients while reducing potential exposure to the virus.…”

A cost comparison of travel models and behavioural telemedicine for rural, Native American populations in New Mexico

“…Over the last three decades the use of telehealth has grown significantly [11][12][13] and telebehavioural health is recognized as a national strategy for improving access to mental health services in Native American communities. 14 Yet, while the clinical outcomes of telemedicine programmes are generally considered to be equivalent to face to face care, [15][16][17][18][19][20][21] the economic impact of these programmes is still an open research question. A number of reviews have looked at the economic impact of telehealth programmes and, overall, have found no conclusive evidence of cost-effectiveness.…”

Telemedicine Infectious Diseases Consultations and Clinical Outcomes: A Systematic Review

“…Mortality was higher in the telemedicine group in 2 studies and lower in the other 2 studies reporting this outcome (range for all studies, 0%–22%) [15, 25–27], with 1 study reporting 90-day instead of 30-day mortality (higher mortality in the control group) (Table 1) [27]. Only 1 of these studies was statistically significant, with lower mortality in patients receiving in-person rather than telephone-only ID consults [26].…”

“…Costs were lower in the telemedicine groups, but based on projections that may not be generalizable [15, 24, 28, 29]. Antibiotic use was similar between telemedicine groups and controls [25, 27, 30–32].…”