Comparison of Endocrinologists’ Physical Examination Documentation for In-person vs Video Telehealth Diabetes Visits

Abstract

Objective Outpatient diabetes mellitus (DM) care over video telehealth (TH) requires modifications to how endocrinologists complete physical examinations (PEs). But there is little guidance on what PE components to include, which may incur wide variation in practice. We compared endocrinologists’ documentation of DM PE components for in-person (IP) vs.TH visits. Methods Retrospective chart review of 200 notes for new DM patients from ten endocrinologists (ten IP and ten TH visits each) in the Veterans Health Administration (VA) between 4/1/2020–4/1/2022. Notes were scored from 0-10 based on documentation of 10 standard PE components. We compared mean PE scores for IP vs. TH across all clinicians using mixed effects models. Independent samples t-tests were used to compare both mean PE scores within clinician and mean scores for each PE component across clinicians for IP vs. TH. We described virtual care-specific and foot assessment techniques. Results The overall mean(SE) PE score was higher for IP vs. TH [8.3(0.5) vs. 2.2(0.5), p < 0.001]. Every endocrinologist had higher PE scores for IP vs. TH. Every PE component was more commonly documented for IP vs. TH. Virtual care-specific techniques and foot assessment were rare. Conclusion Our study quantifies the degree to which PEs for TH were attenuated among a sample of endocrinologists, raising a flag that process improvements and research are needed for virtual PEs. Organizational support and training could help increase PE completion via TH. Research should examine reliability and accuracy of virtual PE, its value to clinical decision-making, and its impact on clinical outcomes.