Aaron Baum|Peter J. Kaboli|Mark D. Schwartz
Reduced In-Person and Increased Telehealth Outpatient Visits During the COVID-19 Pandemic
VA NY Harbor Healthcare System|Icahn School of Medicine at Mount Sinai|Iowa City VA Health Care System|University of Iowa|VA NY Harbor Healthcare System|New York University
letters10 august 2020reduced inperson increased telehealth outpatient visits covid19 pandemicfreeaaron baum phd peter j kaboli md ms mark schwartz mdaaron baum phdicahn school medicine mount sinai va new york harbor healthcare system new york new york absearch papers author peter j kaboli md msveterans rural health resource centeriowa city va office rural health center access delivery research evaluation iowa city va healthcare system university iowa carver college medicine iowa city iowa pjksearch papers author mark schwartz mdva new york harbor healthcare system new york university school medicine new york new york mdssearch papers authorauthor article disclosure informationhttpsdoiorg107326m203026 sectionsaboutvisual abstractpdf toolsadd favoritesdownload citationstrack citationspermissions sharefacebooktwitterlinkedinredditemail background coronavirus disease 2019 covid19 pandemic many health systems postponing outpatient visits shifting services telehealth 1 however extent inperson visits reduced replaced telehealth visits remains unclearobjective describe changes number inperson telephone video visits us department veterans affairs va outpatient facilities initial 10 weeks covid19 pandemic overall stratified va clinicmethods findings va largest health care provider united states implemented robust covid19 plan response pandemic analyzed data va corporate data warehouse national repository electronic health records visits va facility updated nightly previously assessed reliability accuracy 2the study population included cohort adults visited va health care facility 2008 2018 outcomes included weekly number va outpatient visits stratified inperson telephone video visits based va clinic stop codes clinic based substation identifier encounter occurred limited visits classified va completed patient encounter requires provider interacted patient documented diagnosis procedure code treatment plan va counted visit toward providers workloadwe described trends weekly counts outcome first 20 weeks 2016 2019 2020 addition reported changes count outcome initial 10week pandemic period weeks 11 20 2020 corresponding 11 march 19 may versus prior 10 weeks weeks 1 10 2020 corresponding 1 january 10 march overall va clinicanalyses done stata version 15 statacorp subcommittee human studies va new york harbor healthcare system 01413 approved study waived patient informed consentthe number inperson visits va outpatient facility among patients cohort decreased 18 898 656 weeks 1 10 2020 8 408 268 weeks 11 20 reduction 10 490 388 visits 555 figure 1 period number telephone visits increased 2 539 685 6 070 362 1390 increase weeks 1 10 number video visits increased 425 495 734 547 726 increase weeks 1 10 overall total number va outpatient inperson telehealth visits decreased 21 863 836 weeks 1 10 2020 15 213 177 weeks 11 20 reduction 6 650 659 visits 304 figure 1 contrast number inperson telephone video overall outpatient visits change weeks 1 10 11 20 2016 2019 figure 1figure 1 number va outpatient visits per week 2016 2019 2020the solid line represents total number va outpatient inperson video telephone visits per week 2020 dashed line represents weekly mean total number va outpatient inperson video telephone visits per week 2016 2019 multiple outpatient records person shared date clinic site primary clinic stop code counted 1 visit vertical line represents week 2020 covid19 pandemic began covid19 coronavirus disease 2019 va us department veterans affairs download figure download powerpoint decreases inperson visits increases telehealth visits observed 928 va clinics figure 2 across clinics number inperson visits decreased median 601 interquartile range 487 733 number telehealth visits increased median 1164 interquartile range 552 2103figure 2 percentage change inperson telehealth outpatient visits covid19 pandemic va cliniceach circle represents clinic area circle proportional clinics size defined number unique patients visited clinic 2019 horizontal gray lines along yaxis show univariate distribution percentage change telephone video visits across clinics vertical gray lines along xaxis show univariate distribution percentage change inperson visits across clinics covid19 coronavirus disease 2019 va us department veterans affairs download figure download powerpoint discussion retrospective study adults using va care 10 490 388 fewer inperson visits va outpatient facilities initial 10 weeks covid19 pandemic preceding 10 weeks 56 decrease inperson visits partly offset 2fold increase number telephone video visits overall still 30 decrease number outpatient visits limitations study include veterans predominantly male older compared overall adult us population observe visits nonva providers research needed understand decreased access inperson care increased use telehealth services pandemic may affect patient outcomes 35references1 hollander je carr bg virtually perfect telemedicine covid19 n engl j med 202038216791681 pmid 32160451 doi101056nejmp2003539 crossrefmedlinegoogle scholar2 fihn sd francis j clancy c et al insights advanced analytics veterans health administration health aff millwood 201433120311 pmid 25006147 doi101377hlthaff20140054 crossrefmedlinegoogle scholar3 starfield b shi l macinko j contribution primary care health systems health milbank q 200583457502 pmid 16202000 crossrefmedlinegoogle scholar4 basu berkowitz sa phillips rl et al association primary care physician supply population mortality united states 20052015 jama intern med 2019179506514 pmid 30776056 doi101001jamainternmed20187624 crossrefmedlinegoogle scholar5 baum barnett ml wisnivesky j et al association temporary reduction access health care longterm changes hypertension control among veterans natural disaster jama netw open 20192e1915111 pmid 31722027 doi101001jamanetworkopen201915111 crossrefmedlinegoogle scholar comments 0 comments sign submit comment author article disclosure informationauthors aaron baum phd peter j kaboli md ms mark schwartz mdaffiliations icahn school medicine mount sinai va new york harbor healthcare system new york new york abveterans rural health resource centeriowa city va office rural health center access delivery research evaluation iowa city va healthcare system university iowa carver college medicine iowa city iowa pjkva new york harbor healthcare system new york university school medicine new york new york mdssee also editorial comment page 116disclaimer funders role design conduct study collection management analysis interpretation data preparation review approval manuscript decision submit manuscript publication views expressed article authors necessarily represent views va us governmentfinancial support material result work supported resources va new york harbor healthcare system dr kaboli supported va veterans health administration va office rural health office research development health services research development service center access delivery research evaluation cin 13412disclosures disclosures viewed wwwacponlineorgauthorsicmjeconflictofinterestformsdomsnumm203026reproducible research statement study protocol available statistical code available dr baum email aaronbaummssmedu data set access underlying data restricted va employees institutional review boardapproved vaapproved research projectcorresponding author aaron baum phd icahn school medicine mount sinai va new york harbor healthcare system 1216 fifth avenue suite 559 new york ny 10029 email aaronbaummssmeduthis article published annalsorg 10 august 2020 previousarticlenextarticle advertisement figuresreferencesrelateddetailssee alsovirtual care pandemic reaching patients carolyn clancy susan kirsh metrics cited bydisparities routine healthcare utilization disruptions covid19 pandemic among veterans type 2 diabetesnational trends prevalence chronic kidney disease among korean adults 20072020the covid19 pandemic negatively impact frequency continuity outpatient care alberta canadadetermining trend public interest pediatric solid tumors pre postcovid pandemic analysisimpacts covid19 drug treatment court operations lessons learned normalization process theorythe professional agenda effect implementation telemedicine among primary care physicians qualitative studyvisit betweenvisit interaction frequency covid19 telehealth implementationvideoconferencing movementbased psychologically informed interventions chronic pain systematic review horizon scanimpact covid19 pandemic nonpharmacological pain management trials military veteran healthcare settings evaluation informed implementation sciencebrief report telehealth musicenhanced reciprocal imitation training autism singlesubject feasibility study virtual parent coaching interventionchanges lifestylerelated behaviour covid19 pandemic japan questionnaire survey examinees underwent annual health checkupquantifying digital divide associations broadband internet telemental health access covid19 pandemicpatient provider perspectives personal health record use multisite qualitative study hiv care settingschanges burnout moral distress among veterans health administration va physicians covid19 pandemicexcess mortality veterans health administration facilities covid19 pandemicevaluating effectiveness costeffectiveness free influenza vaccination policy older adults yinzhou china study protocol realworld analysesartificial intelligenceassisted smartphonebased sensing bioanalytical applications reviewthe impact covid19 pandemic blood pressure control stroke transient ischemic attack among patients va medical centerseffectiveness smoking cessation program covid19 pandemicpatient characteristics associated telehealth scheduling completion primary care large urban public healthcare systemhealth care implications covid19 pandemic cardiovascular practitionergiving patients less work thematic analysis telehealth use recommendations improve usability autistic adultsthe latent tuberculosis infection cascade care covid19 pandemic response midsized us cityreceipt medications chronic disease first 2 years covid19 pandemic among enrollees feeforservice medicarepayment coverage parity virtual care inperson care get therecoping covid performance chinas hierarchical medical system covid19 pandemicimpact covid19 pandemic health care utilization vaccine safety datalink retrospective cohort study preprintnavigating covid19 related challenges completing clinical trials lessons patriot stepup randomized prevention trialscommunityintegrated selfcollected hpvbased cervix screening lowresource rural setting pragmatic clusterrandomized trialdisparities telemedicine use among louisiana medicaid beneficiaries covid19 pandemicimpact covid19 trends outpatient clinic utilizationprivate equity ophthalmology optometry time series analysis 2012 2021evaluation outpatient access greek health system considering constraints covid19 pandemicevaluation telehealth training package remotely teach caregivers conduct discretetrial instructionusing telehealth provide interventions children asd systematic reviewa pilot study brief stepped behavioral activation primary care patients depressive symptomsexploration cardiology patient hospital presentations health care utilisation cardiovascular risk factors covid19 pandemicinforming use telehealth managing chronic conditions mixedmethods evaluation telehealth use manage heart failure covid19frequency type outpatient visits patients cardiovascular ambulatorycare sensitive conditions covid19 pandemic subsequent outcomes retrospective cohort studydigital health literacy covid19 outbreak among frail nonfrail cardiology patients digicovid studytelehealth use australian primary healthcare covid19 crosssectional descriptive surveycharacteristics health care use patients attending virtual walkin clinics ontario canada crosssectional analysisoccupational factors associated telemedicine use japanese workingage population webbased study conducted covid19 pandemiceffect announcement humantohuman transmission telemedicine services china covid19noninterventional studies covid19 era methodological considerations study design analysisethical dilemmas facing substance use counselors covid19 pandemicreproducibility acceptability short physical function tests scores obtained via virtual versus facetoface assessmentsvideobased educational interventions patients chronic illnesses systematic reviewchanges mobility amid covid19 pandemic sapporo city japan investigation relationship spatiotemporal population density urban facilitiesinfluence synchronous primary care telemedicine versus inperson visits diabetes hypertension hyperlipidemia outcomes systematic reviewveterans ambulatory care experience covid19 veterans access satisfaction primary care early pandemica multicentre validation study smartphone application screen hand arthritisoutpatient visit trends internal medicine ambulatory care sensitive conditions covid19 pandemic timeseries analysisexploring digital divide among bhutanese refugee community covid19 engaged research actiontelemedicine safe medication stewardship covid19 digital transformation global pandemican analysis google trends covid19 determining public urological cancer concernsthe use virtual visits obesity pharmacotherapy patients overweight obesity compared inperson encountershospitalbased ambulatory clinic adoption video telephone visits covid19 pandemic convergent mixedmethods studyinfluence covid19 pandemic overall physician visits telemedicine use among patients type 1 type 2 diabetes japanassociation adequacy broadband internet service access primary care veterans health administration covid19 pandemiccollateral effect covid19 pandemic cardiology service provision cardiovascular mortality populationbased study covidcorlta thin line helpful harmful internet usage embodied research internet experiences among adolescent young adult cancer patientsgeneral practice perspective use telehealth covid19 pandemic australia using action research approach qualitative studyimpacto de la pandemia del covid19 en la carga de trabajo de la radiologa en colombiaeffect comprehensive telehealth intervention vs telemonitoring care coordination patients persistently poor type 2 diabetes controlchanges us veterans access specialty care covid19 pandemicthe influence pandemic fear contagion blood pressure management adherence medication hypertensive older adults turkeyaccess telepharmacy services may reduce hospital admissions outpatient populations covid19 pandemicchanges industry marketing payments physicians covid19 pandemic quasi experimental differenceindifference studybehavioral activation livein migrant home care workers care recipients israel pilot studyimplementation telehealth psychiatric care va emergency departments urgent care clinicsusing administrative data examine telemedicine usage among medicaid beneficiaries coronavirus disease 2019 pandemichow essential inperson clinic visits maintenance treatment children acute lymphoblastic leukemiaquality care outcomes patients acute ischemic stroke transient ischemic attack covid19 pandemicimpact covid19 people experiencing homelessness call critical accountabilityprocess miningdriven analysis covid19s impact vaccination patternscovid 19 behavioral questionnaire cobq comparing pandemics impact health behavior three us statesthe impact covid19related transition telehealth visit adherence mental health care interrupted time series studya primary care telehealth pilot program improve access associations patients health care utilization costschanges incidence rates outcomes interest vaccine safety studies covid19 pandemicthe impact covid19 pandemic medical conditions medication adherence people chronic diseasesecg utilization patterns patients arrhythmias covid19 epidemic postsarscov2 eras shanghai chinacrossing digital divide veteran affairs program distribute videoenabled devices patients supportive housing programoutpatient wound clinics covid19 maintained quality served fewer patientsimpact telehealth health care resource utilization covid19 pandemictrends disparities use telehealth among injured workers covid19 pandemicimpact transition facetoface telehealth behavioral obesity treatment covid19 pandemictelehealth use among older adults covid19 associations sociodemographic health characteristics technology device ownership technology learningmanagement colorectal cancer covid19 pandemic recommendations statewide multidisciplinary cancer collaborativemedication prescribing facetoface versus telehealth consultations covid19 pandemic australian general practice retrospective observational studytelehealthbased diagnostic testing general practice covid19 pandemic observational studyvirtual specialist care covid19 pandemic multimethod study patient experience preprintleveraging telehealth improve diabetes caredevelopment telemedicine tools emphasis visual observationtreatment persistence reninangiotensinaldosteronesystem inhibitors time heart failure reduced ejection fractiondisruption medical care among individuals southeastern united states covid19 pandemicuse wearables implantable devices monitor pulmonary health outpatient settinguse extended reality medicine covid19 pandemica multicenter randomized controlled trial comparing gamification remote monitoring standard rehabilitation patients arthroscopic shoulder surgerydelayed followup visits thyrotropin among patients levothyroxine covid19 pandemicgeriatric health care covid19 pandemic managing health crisistelehealth longitudinal management chronic conditions systematic reviewsocial determinants health hypertension control adults medicaideffect covid19 pandemic adversity individuals receiving anticoagulation atrial fibrillation nationally representative administrative health claims analysishealth care utilization among texas veterans health administration enrollees hurricane harvey 20162018can see screen addressing racial ethnic disparities telehealthrisk factors associated physician trainee concern missed educational opportunities covid19 pandemicdivergent trends emergency department presentations amid novel coronavirus disease 2019 pandemic chicago illinoisinsomnia disorder among coronavirus disease survivors south korean nationwide cohort studyintegrated care management improve diabetes outcomes refugee immigrant patients icareadmissions norwegian hospitals covid19 pandemicchanges treatment patients incident eskd novel coronavirus disease 2019 pandemicassessment changes us veterans health administration care delivery methods covid19 pandemicthe impact covid19 pandemic governor mandated stay home order emergency department super utilizershiv care using differentiated service delivery covid19 pandemic nationwide cohort study us department veterans affairschanges use telehealth facetoface chiropractic care department veterans affairs covid19 pandemicdo hospitals need extend telehealth services experimental study different telehealth modalities covid19 pandemicpublic health literacy knowledge awareness regarding antibiotic use antimicrobial resistance covid19 pandemic crosssectional studycall center remote triage nurse practitioners associated fewer subsequent facetoface healthcare visitsphysician visits medication prescriptions major chronic diseases covid19 pandemic japan retrospective cohort studybarriers facilitators telemedicine hear nowimplications covid19 pandemic cardiovascular disease riskfactor managementcharacterizing managing physicians claims sequences episodes caredelivering personalized care distance telemedicine foster getting know patient personvirtual care pandemic reaching patientscarolyn clancy md susan kirsh md mphimpact covid19 pandemic health care utilization large integrated health care system retrospective cohort studyacceptability research health care visits covid19 pandemic crosssectional survey studyage social disparities use telemedicine covid19 pandemic japan crosssectional studyusing administrative data explore potentially aberrant provision virtual care covid19 retrospective cohort study ontario provincial datadisparities outpatient telehealth visits covid19 pandemic large integrated health care organization retrospective cohort studyimpact coronavirus disease 2019 covid19 pandemic medical use military hospitals koreavirtual care use covid19 pandemic repeated crosssectional studyhealthseeking behavior patients cardiovascular diseases covid19 epidemic postepidemic period shanghai chinaimpact covid19 pandemic cancer care deliverycoronavirus disease 2019 covid19 patient disseminated histoplasmosis hiva case report argentina literature review january 2021volume 174 issue 1 page 129131 keywords adults covid19 disclosure health care health care facilities interquartile range outpatient clinics outpatients telemedicine veteran care epublished 10 august 2020 issue published january 2021 pdf downloadloading