Neal Yuan|Joshua M. Pevnick|Patrick Botting|Y. Elad|Stacy Ann Miller|Susan Cheng|Susan Cheng
Patient Use and Clinical Practice Patterns of Remote Cardiology Clinic Visits in the Era of COVID-19
Cedars-Sinai Smidt Heart Institute|Cedars-Sinai Medical Center|Cedars-Sinai Medical Center|Cedars-Sinai Smidt Heart Institute|Cedars-Sinai Medical Center|Cedars-Sinai Smidt Heart Institute|Cedars-Sinai Medical Center|Cedars-Sinai Medical Center|Cedars-Sinai Smidt Heart Institute|Cedars-Sinai Medical Center|Cedars-Sinai Smidt Heart Institute|Cedars-Sinai Medical Center
h3importanceh3 covid19 pandemic led unprecedented shift ambulatory cardiovascular care inperson remote visits h3objectiveh3 understand whether transition remote visits associated disparities patient use care diagnostic test ordering medication prescribing h3design setting participantsh3 crosssectional study used electronic health records data ambulatory cardiology visits urban multisite health system los angeles county california 2 periods april 1 2019 december 31 2019 precovid april 1 december 31 2020 covidera statistical analysis performed january february 2021 h3exposureh3 inperson remote ambulatory cardiology clinic visit one 31 precovid period covidera period h3main outcomes measuresh3 comparison patient characteristics frequencies medication ordering cardiologyspecific testing across 4 visit types precovid inperson reference covidera inperson covidera video covidera telephone h3resultsh3 study analyzed data 87 182 precovid inperson 74 498 covidera inperson 4720 covidera video 10 381 covidera telephone visits across visits 79 572 patients female 450 127 080 patients nonhispanic white 719 mean sd age 681 170 years patients accessing covidera remote visits likely asian black hispanic individuals 24 934 precovid inperson visits 286 vs 19 742 covidera inperson visits 265 vs 3633 covidera video visits 304 vs 1435 covidera telephone visits 350ipi lt 001 comparisons private insurance 34 063 precovid inperson visits 391 vs 25 474 covidera inperson visits 342 vs 2562 covidera video visits 543 vs 4264 covidera telephone visits 411ipi lt 001 covidera inperson vs video covidera inperson vs telephone cardiovascular comorbidities eg hypertension 37 166 precovid inperson visits 426 vs 31 359 covidera inperson visits 421 vs 2006 covidera video visits 425 vs 5181 covidera telephone visits 499ipi lt 001 covidera inperson vs telephone heart failure 14 319 precovid inperson visits 164 vs 10 488 covidera inperson visits 141 vs 1172 covidera video visits 248 vs 2674 covidera telephone visits 258ipi lt 001 covidera inperson vs video covidera inperson vs telephone adjusting patient visit characteristics comparison precovid inperson visits video telephone visits clinicians lower odds ordering medication covidera inperson odds ratio 062 95 ci 060064 covidera video 022 95 ci 020024 covidera telephone 014 95 ci 013015 tests electrocardiograms covidera inperson 060 95 ci 058062 covidera video 003 95 ci 002004 covidera telephone 002 95 ci 001003 echocardiograms covidera inperson 121 95 ci 118124 covidera video 047 95 ci 042052 covidera telephone 028 95 ci 025031 h3conclusions relevanceh3 patients asian black hispanic private insurance least one several cardiovascular comorbidities used remote cardiovascular care frequently covidera period clinician ordering diagnostic testing medications consistently decreased comparing precovid vs covidera inperson vs remote visits studies needed clarify whether decreases represent reduction overuse tests medications vs underuse indicated testing prescribing