The Impact of Telemedicine on Quality of Care for Patients with Diabetes After March 2020

Abstract

Background The impact of telemedicine on ambulatory care quality is a key question for policymakers as they navigate payment reform for remote care. Objective To evaluate whether utilizing telemedicine in the first 9 months of the COVID-19 pandemic impacted performance on a diabetes quality of care measure for patients at a large academic medical center. We hypothesized care quality would reduce less among telemedicine users. Design Quasi-experimental design using binomial logistic regression. Covariates included age, gender, race, ethnicity, type of insurance, hierarchical condition category score, primary language at the individual level, and zip code–level income. Participants All adult patients younger than 75 years of age diagnosed with type 2 diabetes mellitus (N = 16,588) as of 3/19/2020 at a single academic health center. Interventions Completion of one or more telemedicine encounters with an institutional primary care physician or endocrinologist between 3/19/2020 and 12/19/2020. Main Measures The components met in a five-item composite measure of diabetes quality of care, as of patients’ last clinical encounter. Items were (1) systolic blood pressure less than 140 mmHg, (2) hemoglobin A1c less than 8.0%, (3) using a statin and (4) aspirin, and (5) tobacco non-use. Key Results From the pre- to post-period, the probability of meeting any given component of the composite measure for patients only utilizing in-person care was 21% lower (OR, 95% CI 0.79; 0.76, 0.81) and for the telemedicine users 2% lower (OR 0.98; 0.85, 1.13). There was an increased likelihood of meeting any given component among telemedicine users compared to in-person care alone (OR 1.25; 1.08, 1.44). Conclusions Patients with diabetes utilizing telemedicine performed similarly on a composite measure of diabetes care quality compared to before the pandemic. Those not utilizing telemedicine had reductions. Telemedicine use maintained quality of care for patients with diabetes during the first 9 months of the COVID-19 pandemic.

Variation in initial and continued use of primary, mental health, and specialty video care among Veterans

“…Critically, more information is needed to identify whether the quality of video-based care is comparable to in-person care across specific subtypes of care such as specialty care. Early work in VA indicates that virtual care may be comparable for the management of diabetes, 46,47 and mental health video care is highly regarded as equal to in-person care. [48][49][50][51] Several limitations should be noted.…”

Assessing the Impact of Telemedicine Implementation in Diverse Health Care Systems

“…This supplemental issue also advances evidence by examining the telemedicine and quality of care relationship for adults with diabetes insured by Medicaid and Medicare populations. The impact of telemedicine on diabetes care was previously assessed among patients of University of California, Los Angeles Health and health care organizations affiliated with Optum Labs 21,22. These studies find that telemedicine helped maintain diabetes care during the pandemic, but it remained unclear whether these results generalized to health care systems serving vulnerable populations.…”

Analyzing the Effect of Telemedicine on Domains of Quality Through Facilitators and Barriers to Adoption: Systematic Review

“…Telemedicine and its quality have been examined from a specialty point of view, but there has not been a comprehensive look across specialties. Telemedicine has been studied for its quality implications in diabetes [ 8 ]; liver disease [ 9 ]; pediatrics [ 10 ]; gastroenterology [ 11 ]; ears, nose, and throat [ 12 ]; respiratory care [ 13 ]; rheumatoid arthritis [ 14 ]; and alcohol use disorder [ 15 ]. Each study provides a mix of reviews on quality [ 16 - 18 ].…”