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. 2021 Nov 1;4(11):e2132917.
doi: 10.1001/jamanetworkopen.2021.32917.

Analysis of Clinician and Patient Factors and Completion of Telemedicine Appointments Using Video

Bradley H Crotty  1   2 , Noorie Hyun  1 , Alexandra Polovneff  1 , Yilu Dong  1 , Michael C Decker  3 , Natalie Mortensen  2 , Jeana M Holt  1   2   4 , Aaron N Winn  1 , Purushottam W Laud  1 , Melek M Somai  1   2
Affiliations

Analysis of Clinician and Patient Factors and Completion of Telemedicine Appointments Using Video

Bradley H Crotty et al. JAMA Netw Open. .

Abstract

Importance: Telemedicine provides patients access to episodic and longitudinal care. Policy discussions surrounding future support for telemedicine require an understanding of factors associated with successful video visits.

Objective: To assess patient and clinician factors associated with successful and with failed video visits.

Design, setting, and participants: This was a quality improvement study of 137 846 scheduled video visits at a single academic health system in southeastern Wisconsin between March 1 and December 31, 2020, supplemented with patient experience survey data. Patient information was gathered using demographic information abstracted from the electronic health record and linked with block-level socioeconomic data from the US Census Bureau. Data on perceived clinician experience with technology was obtained using the survey.

Main outcomes and measures: The primary outcome of interest was the successful completion of a scheduled video visit or the conversion of the video visit to a telephone-based service. Visit types and administrative data were used to categorize visits. Mixed-effects modeling with pseudo R2 values was performed to compare the relative associations of patient and clinician factors with video visit failures.

Results: In total, 75 947 patients and 1155 clinicians participated in 137 846 scheduled video encounters, 17 190 patients (23%) were 65 years or older, and 61 223 (81%) patients were of White race and ethnicity. Of the scheduled video encounters, 123 473 (90%) were successful, and 14 373 (10%) were converted to telephone services. A total of 16 776 patients (22%) completed a patient experience survey. Lower clinician comfort with technology (odds ratio [OR], 0.15; 95% CI, 0.08-0.28), advanced patient age (66-80 years: OR, 0.28; 95% CI, 0.26-0.30), lower patient socioeconomic status (including low high-speed internet availability) (OR, 0.85; 95% CI, 0.77-0.92), and patient racial and ethnic minority group status (Black or African American: OR, 0.75; 95% CI, 0.69-0.81) were associated with conversion to telephone visits. Patient characteristics accounted for systematic components for success; marginal pseudo R2 values decreased from 23% (95% CI, 21.1%-26.1%) to 7.8% (95% CI, 6.3%-9.4%) with exclusion of patient factors.

Conclusions and relevance: As policy makers consider expanding telehealth coverage and hospital systems focus on investments, consideration of patient support, equity, and friction should guide decisions. In particular, this quality improvement study suggests that underserved patients may become disproportionately vulnerable by cuts in coverage for telephone-based services.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Crotty reported being an advisor for Buoy Health outside the submitted work. Dr Winn reported receiving personal fees from Takeda outside the submitted work. Dr Laud reported receiving grants from the National Institutes of Health and from the US Department of Defense, US Department of the Navy as part of a subcontract from the National Marrow Donor Program outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Video Visit Trends (by Platform) and Success Rate of Completing the Visit as a Video-Based Encounter
See this image and copyright information in PMC

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