Association of Physician Characteristics With Early Adoption of Virtual Health Care

Zachrison, Kori S; Yan, Zhiyu; Samuels‐Kalow, Margaret; Licurse, Adam; Zuccotti, Gianna; Schwamm, Lee H

doi:10.1001/jamanetworkopen.2021.41625

Cited by 14 publications

(12 citation statements)

References 14 publications

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“…The findings of our physician characteristics that were associated with IVUS use, such as generation and procedural numbers, tally with previous data on the subject that show that both a physician’s generation and patient numbers are associated with being an early adopter of technology ( 19 ). In order to maximize IVUS use in the correct patients, facilitating IVUS use for trainees and putting extra resources into training older and lower-volume operators may be a successful strategy.…”

Section: Discussionsupporting

confidence: 86%

Real-world intravascular ultrasound (IVUS) use in percutaneous intervention-naïve patients is determined predominantly by operator, patient, and lesion characteristics

Tindale

Panoulas

2022

Front. Cardiovasc. Med.

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BackgroundIntravascular Ultrasound (IVUS) has been shown to improve clinical outcomes in patients undergoing percutaneous intervention (PCI) in numerous trials. However, it is still underutilized outside of trial settings, and most trials include a significant proportion of patients with prior PCI. The aim of this study is to look at real-world use and outcomes in PCI-naïve patients who undergo IVUS-guided intervention.Methods and resultsProspectively collected data from 10,574 consecutive patients undergoing their index PCI was retrospectively analyzed. 455 (4.3%) patients underwent IVUS, with a median follow-up of 4.6 years. Patients undergoing IVUS had higher levels of comorbidities including diabetes (27.5% vs. 19.7%, p < 0.001), hypertension (58.0% vs. 47.9%, p < 0.001), hypercholesterolemia (51.6% vs. 39.2%, p < 0.001) and were generally older (65.9 ± 14.5 vs. 64.5 ± 13.4 years, p = 0.031) with higher mean baseline creatinine levels (95.4 ± 63.3 vs. 87.8 ± 46.1 μmol/L). The strongest predictor of IVUS use was the operating consultant graduating from medical school after the year 2000 [OR 14.5 (3.5–59.8), p < 0.001] and the presence of calcific lesions [OR 5.2 (3.4–8.0) p < 0.001]. There was no significant difference in MACE nor 1-year mortality between patients undergoing IVUS-guided or angiography-only PCI on unadjusted analysis [OR 1.04 (0.73—1.5), p = 0.81, OR 1.055 (0.65–1.71) p = 0.828] nor mortality throughout the study period (HR 0.93 (0.69—1.26), p = 0.638). This held true for stents longer than 28 mm. Propensity matched analysis of patients similarly showed no mortality difference between arms for all patients and those with longer stents (p = 0.564 and p = 0.919).ConclusionThe strongest predictors of IVUS use in PCI-naïve patients are the operator’s year of graduation from medical school and proxy measures of calcific lesions. On both matched and adjusted analysis there was no evidence of improved mortality nor reduced MACE in this specific retrospective cohort, although this may well be explained by significant selection bias.

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Section: Discussionsupporting

confidence: 86%

Real-world intravascular ultrasound (IVUS) use in percutaneous intervention-naïve patients is determined predominantly by operator, patient, and lesion characteristics

Tindale

Panoulas

2022

Front. Cardiovasc. Med.

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“…One study evaluating provider characteristics associated with adoption of virtual healthcare showed that female, primary care (versus surgical care), and behavioral health physicians were most likely to be early adopters of virtual health. 73 In this same study, characteristics of physicians' patients showed a weaker association to early adoption than provider characteristics. However, notably, having a higher percent of patients from a racial or ethnic "minority" group was associated with lower odds of early adoption.…”

Section: Focused Updatesmentioning

confidence: 79%

Telehealth Trials to Address Health Equity in Stroke Survivors

Sharrief

Guzik

Jones

et al. 2023

Stroke

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Telehealth has seen rapid expansion into chronic care management in the past 3 years because of the COVID-19 pandemic. Telehealth for acute care management has expanded access to equitable stroke care to many patients over the past two decades, but there is limited evidence for its benefit for addressing disparities in the chronic care of patients living with stroke. In this review, we discuss advantages and disadvantages of telehealth use for the outpatient management of stroke survivors. Further, we explore opportunities and potential barriers for telehealth in addressing disparities in stroke outcomes related to various social determinants of health. We discuss two ongoing large randomized trials that are utilizing telehealth and telemonitoring for management of blood pressure in diverse patient populations. Finally, we discuss strategies to address barriers to telehealth use in patients with stroke and in populations with adverse social determinants of health.

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“…Reasons contributing to this varied uptake of technology are likely to be multifactorial, including companies' different regional marketing strategies, different regional hospital competition, and various cultural attitudes regarding technology in physicians and patients. 12,[29][30][31][32] Also, surgeons' learning curve can influence the uptake of technology as technology-assisted TKA usually takes longer operative time compared to conventional TKA in inexperienced surgeons. [33][34][35] High equipment expenses can be another obstacle to new technology adoption.…”

Section: Discussionmentioning

confidence: 99%

The trend and future projection of technology‐assisted total knee arthroplasty in the United States

Lan

Chen

Niu

et al. 2022

Robotics Computer Surgery

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Background: As technology-assisted surgery has boosted in the last decades, we aimed to investigate the factors affecting adoption and to predict the future utilization of technology among patients who underwent total knee arthroplasty (TKA).Methods: Patients underwent TKA in 2017-2019 in the MarketScan Database were included. Percentage of technology-assisted surgery was calculated. Multivariable logistic regression models were performed to analyse the factors and make the prediction.Results: Of 112,161 TKA procedures, 7.2% were technology-assisted. The proportion of technology-assisted TKA is expected to reach 50% by 2032. The West showed the highest proportion of technology-assisted TKA (12.3%), while the South had the lowest (5.7%). Over time, the Midwest showed the greatest increase in technology adoption (OR = 1.26 compared to the Northeast, 95% CI [1.15, 1.38]).Conclusions: Technology adoption rate of TKA will continue to increase for the next 20 years in the United States with a slight geographical variation.

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Association of Physician Characteristics With Early Adoption of Virtual Health Care

Cited by 14 publications

References 14 publications

Real-world intravascular ultrasound (IVUS) use in percutaneous intervention-naïve patients is determined predominantly by operator, patient, and lesion characteristics

Real-world intravascular ultrasound (IVUS) use in percutaneous intervention-naïve patients is determined predominantly by operator, patient, and lesion characteristics

Telehealth Trials to Address Health Equity in Stroke Survivors

The trend and future projection of technology‐assisted total knee arthroplasty in the United States

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