Evaluating the Comparative Effectiveness of Telemedicine in Primary Care: Learning From the COVID-19 Pandemic
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Asthma
- Sponsor
- Weill Medical College of Cornell University
- Enrollment
- 216000
- Locations
- 4
- Primary Endpoint
- Preventable Emergency Department (ED) Admissions
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
Leveraging a natural experiment approach, the investigators will examine rapidly changing telemedicine and in-person models of care during and after the COVID-19 crisis to determine whether certain patients could safely choose to continue telemedicine or telemedicine-supplemented care, rather than return to in-person care.
Detailed Description
During the COVID-19 pandemic, telemedicine has quickly emerged as the primary method of providing outpatient care in many regions with shelter-in-place and social distancing policies. It is critical to understand the impact of this rapid and widespread transition from in-person to remote visits on disparities in access to primary care, especially in chronic disease where ongoing communication between providers and patients is essential. Also, these newly developed or expanded telemedicine programs vary widely, raising important questions about the effect of these differences on uptake of telemedicine among different patient populations and on patient-centered outcomes. Leveraging a natural experiment approach, the investigators will examine rapidly changing telemedicine and in-person models of care during and after the COVID-19 crisis to determine whether certain patients could safely choose to continue telemedicine or telemedicine-supplemented care, rather than return to in-person care. The overarching goals of this study are to describe the features of telemedicine programs in primary care during the COVID-19 pandemic and to use natural experiment methods to provide rigorous evidence on the effects of these programs. PCORI has granted an extension for the final research report to July 30, 2023.
Investigators
Eligibility Criteria
Inclusion Criteria
- •patients that are attributed to primary care clinics across four health systems in the INSIGHT (Mount Sinai Health System and Weill Cornell Medicine), OneFlorida (University of Florida Health), and STAR (University of North Carolina Health) CRNs.
- •Patients received two or more outpatient visits at a participating practice during a one-year period before the COVID-19 pandemic,
- •Patients had one or more of five chronic illnesses (asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes, hypertension) as defined by the Medicare Chronic Conditions Warehouse algorithm
Exclusion Criteria
- •Patients who tested COVID-positive
- •Patients from hospice and palliative care practices
- •Patients from osteopathic medicine practices
- •Patients from pediatric practices
Outcomes
Primary Outcomes
Preventable Emergency Department (ED) Admissions
Time Frame: Assessed per person per quarter for 3 years, data collected encompasses retrospective data from Q1 2019 to Q4 2021
Avoidable emergency department (ED) admissions will be obtained from claims data. The Effect of telemedicine on preventable emergency department admissions will be calculated using difference-in-differences methodology. The estimate coefficient of the difference-in-difference model will be reported.
Unplanned Hospital Admissions From the ED
Time Frame: Assessed at the quarter level for 3 years, data collected encompasses retrospective data from Q1 2019 to Q4 2021
Unplanned hospital admissions from the ED will be obtained from claims data. The effect of telemedicine on unplanned hospital admissions will be calculated using difference-in-difference methodology. The estimate coefficient will be reported.
Continuity of Care as Assessed by the Breslau Usual Provider of Care Measure
Time Frame: 12 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Continuity of care as assessed by the Breslau Usual Provider of Care measure. The Breslau Usual Provider of Care index is also an indicator of continuity of care, ranging from 0 to 1, where 1 represents continuity of care.
Number of Unplanned Hospital Admissions From the ED
Time Frame: 12 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Unplanned hospital admissions from the ED will be obtained from claims data
Continuity of Care as Assessed by the Bice-Boxerman Continuity of Care Index
Time Frame: 12 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Continuity of care will be measured using the Bice-Boxerman Continuity of Care Index. The Bice-Boxerman continuity of care (COC) index reflects the relative share of all of a patient's visits during the year that are billed by distinct providers and/or practices. The index ranges from 0 to 1, where 0 indicates that each visit involved a different provider than all other visits, and 1 that all visits were billed by a single provider, representing continuity of care.
Number of Avoidable Emergency Department (ED) Admissions
Time Frame: 12 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Avoidable emergency department (ED) admissions will be obtained from claims data
Continuity of Care as Assessed by Attendance at Follow-up Appointment
Time Frame: 12 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Continuity of care as assessed by attendance at follow-up appointment.
Secondary Outcomes
- Evidence of Controlled Disease as Indicated by as Indicated by the National Quality Forum (NQF 0059): Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)(12 months after the exposure to one of the comparator arms of clinic-level telemedicine used)
- Evidence of Controlled Disease as Indicated by as Indicated by the National Quality Forum (NQF 0018): Controlling High Blood Pressure(12 months after the exposure to one of the comparator arms of clinic-level telemedicine used)
- Days at Home(12 months after the exposure to one of the comparator arms of clinic-level telemedicine used)
- Patient Experiences Based on the Patient Satisfaction Questionnaire (PSQ-18)(12 months after the exposure to one of the comparator arms of clinic-level telemedicine used)
- Ease of Use and Access to Telemedicine Based on Telehealth Usability Questionnaire (TUQ)(12 months after the exposure to one of the comparator arms of clinic-level telemedicine used)