Outcomes of In-Person and Telehealth Ambulatory Encounters During COVID-19 Within a Large Commercially Insured Cohort.
Outcomes of In-Person and Telehealth Ambulatory Encounters During COVID-19 Within a Large Commercially Insured Cohort.
复制标题
在大型商业保险人群中，在Covid-19期间，面对面和远程医疗的遭遇的结果。
DOI：
10.1001/jamanetworkopen.2022.8954
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发表时间：
2022-04-01
影响因子：
13.8
通讯作者：
Weiner, Jonathan P.
中科院分区：
文献类型：
--
作者：
Hatef, Elham;Lans, Daniel;Bandeian, Stephen;Lasser, Elyse C.;Goldsack, Jennifer;Weiner, Jonathan P.
在美国新冠肺炎大流行期间，远程医疗与面对面接触与护理结果之间有什么联系？在这项针对4070万患有急性临床疾病的美国商业保险成年人的队列研究中，与面对面的接触相比，那些最初有远程医疗接触的人，任何后续接触、急诊科接触和住院的几率都更高。对于患有慢性病的人来说，那些最初有远程健康接触的人的几率较低。接受急性和慢性病远程保健的成员之间的后续护理模式截然不同，对新冠肺炎大流行期间和之后的卫生服务产生了影响。这项队列研究评估了在新冠肺炎大流行期间，在有商业保险的急性临床条件下的美国成年人中，远程医疗与面对面门诊医疗接触的相关结果。自新冠肺炎大流行开始以来，很少有研究评估远程保健与护理结果的相关性，包括初次接触后的卫生保健使用模式。评估在新冠肺炎大流行期间远程保健和面对面访问与护理结果之间的关联。这项队列研究评估了2019年7月1日至2020年12月31日期间连续加入蓝十字和蓝盾协会私人健康计划的成员。主要结果是根据登记档案、从业者声明和与登记人的邮政编码相关的社区特征对每个登记人的流动遭遇进行分层。护理结果在初次接触后14天进行评估，包括任何类型的后续接触、急诊科接触以及首次远程医疗或面对面接触后的住院治疗。在这项针对40名 739 915个人(平均年龄35.37[18.77]岁；女性20 480 768[50.3%])的队列研究中，从2019年到2020年，门诊就诊减少了1.0%，每个参与者的面对面就诊次数减少了17.0%；然而，远程医疗就诊在所有门诊就诊中所占的比例从0.6%(n = 236 220)大幅增加到14.1%(n = 5 743 718)。对于因新的急性疾病而首次远程医疗接触的成员，所有随访合并的调整后优势比为1.44(95%可信区间，1.42-1.46)，急诊科会面调整后的优势比为1.11(95%可信区间，1.06-1.16)。对于因新的慢性病首次远程医疗接触的成员，所有随访合并的调整后优势比为0.94(95%CI，0.92-0.95)，住院治疗调整后的优势比为0.94(95%CI，0.90-0.99)。在这项对4070万有商业保险的成年人进行的队列研究中，远程医疗在大流行高峰期的门诊就诊中占了很大份额，在感染率下降后仍然很普遍。慢性病的远程医疗接触与这些疾病的面对面接触的随访率相似，而急性情况的远程健康接触似乎比面对面接触更有可能需要随访。这些发现为今后的工作指明了方向，并与政策制定者、支付者和从业者在新冠肺炎大流行期间和之后管理远程卫生的使用有关。
What is the association of telehealth vs in-person encounters with outcomes of care during the COVID-19 pandemic in the US? In this cohort study of 40.7 million US commercially insured adults with acute clinical conditions, those with an initial telehealth encounter, compared with an in-person encounter, had higher odds for any follow-up encounter, an emergency department encounter, and in-patient admissions. For people with chronic conditions, the odds were lower for those with an initial telehealth encounter. The contrasting patterns of follow-up care among members receiving telehealth for acute and chronic conditions have implications for health services during and after the COVID-19 pandemic. This cohort study assesses outcomes associated with telehealth vs in-person ambulatory health care encounters among commercially insured US adults with acute clinical conditions during the COVID-19 pandemic. Since the start of the COVID-19 pandemic, few studies have assessed the association of telehealth with outcomes of care, including patterns of health care use after the initial encounter. To assess the association of telehealth and in-person visits with outcomes of care during the COVID-19 pandemic. This cohort study assessed continuously enrolled members in private health plans of the Blue Cross and Blue Shield Association from July 1, 2019, to December 31, 2020. Main outcomes were ambulatory encounters per enrollee stratified by characteristics derived from enrollment files, practitioner claims, and community characteristics linked to the enrollee’s zip code. Outcomes of care were assessed 14 days after the initial encounters and included follow-up encounters of any kind, emergency department encounters, and hospitalizations after initial telehealth or in-person encounters. In this cohort study of 40 739 915 individuals (mean [SD] age, 35.37 [18.77] years; 20 480 768 [50.3%] female), ambulatory encounters decreased by 1.0% and the number of in-person encounters per enrollee decreased by 17.0% from 2019 to 2020; however, as a proportion of all ambulatory encounters, telehealth encounters increased substantially from 0.6% (n = 236 220) to 14.1% (n = 5 743 718). For members with an initial telehealth encounter for a new acute condition, the adjusted odds ratio was 1.44 (95% CI, 1.42-1.46) for all follow-ups combined and 1.11 (95% CI, 1.06-1.16) for an emergency department encounter. For members with an initial telehealth encounter for a new chronic condition, the adjusted odds ratios were 0.94 (95% CI, 0.92-0.95) for all follow-ups combined and 0.94 (95% CI, 0.90-0.99) for in-patient admissions. In this cohort study of 40.7 million commercially insured adults, telehealth accounted for a large share of ambulatory encounters at the peak of the pandemic and remained prevalent after infection rates subsided. Telehealth encounters for chronic conditions had similar rates of follow-up to in-person encounters for these conditions, whereas telehealth encounters for acute conditions seemed to be more likely than in-person encounters to require follow-up. These findings suggest a direction for future work and are relevant to policy makers, payers, and practitioners as they manage the use of telehealth during the COVID-19 pandemic and afterward.
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作者：
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DOI：
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