Growth of Ambulatory Virtual Visits and Differential Use by Patient Sociodemographics at One Urban Academic Medical Center During the COVID-19 Pandemic: Retrospective Analysis (Preprint)

Abstract

BACKGROUND Despite widespread interest in the use of virtual (ie, telephone and video) visits for ambulatory patient care during the COVID-19 pandemic, studies examining their adoption during the pandemic by race, sex, age, or insurance are lacking. Moreover, there have been limited evaluations to date of the impact of these sociodemographic factors on the use of telephone versus video visits. Such assessments are crucial to identify, understand, and address differences in care delivery across patient populations, particularly those that could affect access to or quality of care. OBJECTIVE The aim of this study was to examine changes in ambulatory visit volume and type (ie, in-person vs virtual and telephone vs video visits) by patient sociodemographics during the COVID-19 pandemic at one urban academic medical center. METHODS We compared volumes and patient sociodemographics (age, sex, race, insurance) for visits during the first 11 weeks following the COVID-19 national emergency declaration (March 15 to May 31, 2020) to visits in the corresponding weeks in 2019. Additionally, for visits during the COVID-19 study period, we examined differences in visit type (ie, in-person versus virtual, and telephone versus video visits) by sociodemographics using multivariate logistic regression. RESULTS Total visit volumes in the COVID-19 study period comprised 51.4% of the corresponding weeks in 2019 (n=80,081 vs n=155,884 visits). Although patient sociodemographics between the COVID-19 study period in 2020 and the corresponding weeks in 2019 were similar, 60.5% (n=48,475) of the visits were virtual, compared to 0% in 2019. Of the virtual visits, 61.2% (n=29,661) were video based, and 38.8% (n=18,814) were telephone based. In the COVID-19 study period, virtual (vs in-person) visits were more likely among patients with race categorized as other (vs White) and patients with Medicare (vs commercial) insurance and less likely for men, patients aged 0-17 years, 65-74 years, or ≥75 years (compared to patients aged 18-45 years), and patients with Medicaid insurance or insurance categorized as other. Among virtual visits, compared to telephone visits, video visits were more likely to be adopted by patients aged 0-17 years (vs 18-45 years), but less likely for all other age groups, men, Black (vs White) patients, and patients with Medicare or Medicaid (vs commercial) insurance. CONCLUSIONS Virtual visits comprised the majority of ambulatory visits during the COVID-19 study period, of which a majority were by video. Sociodemographic differences existed in the use of virtual versus in-person and video versus telephone visits. To ensure equitable care delivery, we present five policy recommendations to inform the further development of virtual visit programs and their reimbursement.

Implementing the interRAI Check-Up Comprehensive Assessment: Facilitating Care Planning and Care Coordination during the Pandemic

“…Our findings indicate that telephone and video assessments were not feasible for some patient populations, such as those with cognitive impairment, since care coordinators expressed concerns that these patients lacked insight about their own needs and risks. Similar findings have been shown comparing ability to complete video versus phone assessments in ambulatory care for older patients [24]. Utilization barriers among older adults, including visual and auditory sensory deficits, technical literacy, mental acuity, and lack of technical support have been previously documented [25].…”

“…This study received ethics approval from Brock University in August 2021 (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). For the survey, voluntary participation implied informed consent when entering the Qualtrics survey.…”

An Evidence-Based Roadmap for the Provision of More Equitable Telemedicine

“…It has only been in the past several months that we have begun to see more publications highlighting the inequities that have been observed with rapid telemedicine rollouts across urban health care organizations. 17 18 Many of those studies have identified the areas of need for future research, advocacy, and consideration. To our knowledge, when this article was initially written this is the first study that outlines an evidence-based roadmap to more equitable telemedicine access.…”