Growth of Ambulatory Virtual Visits and Differential Use by Patient Sociodemographics at One Urban Academic Medical Center During the COVID-19 Pandemic: Retrospective Analysis.
Growth of Ambulatory Virtual Visits and Differential Use by Patient Sociodemographics at One Urban Academic Medical Center During the COVID-19 Pandemic: Retrospective Analysis.
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DOI：
10.2196/24544
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发表时间：
2020-12-04
影响因子：
3.2
通讯作者：
Shah SD
中科院分区：
文献类型：
--
作者：
Gilson SF;Umscheid CA;Laiteerapong N;Ossey G;Nunes KJ;Shah SD
尽管在COVID-19大流行期间，人们对使用虚拟（即电话和视频）就诊进行门诊患者护理产生了广泛的兴趣，但缺乏按种族、性别、年龄或保险对大流行期间采用虚拟就诊的研究。此外，迄今为止，对这些社会人口因素对使用电话和视频访问的影响的评价有限。这些评估对于识别、理解和解决不同患者群体之间的医疗服务差异至关重要，特别是那些可能影响医疗服务获得或质量的差异。本研究的目的是在一家城市学术医疗中心，按照患者社会人口统计学，检查COVID-19大流行期间门诊就诊量和类型（即，面对面与虚拟和电话与视频就诊）的变化。我们比较了COVID-19国家紧急状态宣布后的前11周（2020年3月15日至5月31日）与2019年相应周的就诊量和患者社会人口统计数据（年龄，性别，种族，保险）。此外，对于COVID-19研究期间的访视，我们使用多变量logistic回归分析了社会人口统计学的访视类型（即面对面与虚拟访视，电话与视频访视）差异。COVID-19研究期间的总访问量占2019年相应周数的51. 4%（n= 80，081 vs n= 155，884次访问）。尽管2020年COVID-19研究期间与2019年相应周的患者社会人口统计数据相似，但60. 5%（n= 48，475）的访视为虚拟访视，而2019年为0%。在虚拟访视中，61.2%（n= 29，661）为视频访视，38.8%（n= 18，814）为电话访视。在COVID-19研究期间，虚拟（与面对面）访视在种族分类为其他（与白色）的患者和有医疗保险（与商业）保险的患者中更有可能，而在男性、0-17岁、65-74岁或≥75岁（与18-45岁的患者相比）的患者以及有医疗补助保险或保险分类为其他的患者中不太可能。在虚拟访视中，与电话访视相比，0-17岁（vs 18-45岁）的患者更有可能采用视频访视，但所有其他年龄组、男性、黑人（vs白色）患者和有医疗保险或医疗补助（vs商业）保险的患者采用视频访视的可能性较小。虚拟访视包括COVID-19研究期间的大部分门诊访视，其中大部分为视频访视。社会人口学差异存在于使用虚拟与面对面和视频与电话访问。为了确保公平的医疗服务，我们提出了五项政策建议，以告知虚拟访问计划及其报销的进一步发展。
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. 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. 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. 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. 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.
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