Leveraging a natural experiment approach, the investigators will examine rapidly changing telemedicine and in-person models of care during and after the COVID-19 crisis to determine whether certain patients could safely choose to continue telemedicine or telemedicine-supplemented care, rather than return to in-person care.
During the COVID-19 pandemic, telemedicine has quickly emerged as the primary method of providing outpatient care in many regions with shelter-in-place and social distancing policies. It is critical to understand the impact of this rapid and widespread transition from in-person to remote visits on disparities in access to primary care, especially in chronic disease where ongoing communication between providers and patients is essential. Also, these newly developed or expanded telemedicine programs vary widely, raising important questions about the effect of these differences on uptake of telemedicine among different patient populations and on patient-centered outcomes. Leveraging a natural experiment approach, the investigators will examine rapidly changing telemedicine and in-person models of care during and after the COVID-19 crisis to determine whether certain patients could safely choose to continue telemedicine or telemedicine-supplemented care, rather than return to in-person care. The overarching goals of this study are to describe the features of telemedicine programs in primary care during the COVID-19 pandemic and to use natural experiment methods to provide rigorous evidence on the effects of these programs. PCORI has granted an extension for the final research report to October 1, 2023.
Study Type
OBSERVATIONAL
Enrollment
33,100
The exposure of interest was the switch to primary care telemedicine prompted by the COVID-19 epidemic
University of Florida
Gainesville, New York, United States
Mount Sinai
New York, New York, United States
Weill Cornell Medicine
New York, New York, United States
University of North Carolina
Chapel Hill, North Carolina, United States
Preventable Emergency Department (ED) Admissions
Avoidable emergency department (ED) admissions will be obtained from claims data. The Effect of telemedicine on preventable emergency department admissions will be calculated using difference-in-differences methodology. The estimate coefficient of the difference-in-difference model will be reported.
Time frame: Assessed per person per quarter for 3 years, data collected encompasses retrospective data from Q1 2019 to Q4 2021
Unplanned Hospital Admissions From the ED
Unplanned hospital admissions from the ED will be obtained from claims data. The effect of telemedicine on unplanned hospital admissions will be calculated using difference-in-difference methodology. The estimate coefficient will be reported.
Time frame: Assessed at the quarter level for 3 years, data collected encompasses retrospective data from Q1 2019 to Q4 2021
Continuity of Care as Assessed by the Breslau Usual Provider of Care Measure
Continuity of care as assessed by the Breslau Usual Provider of Care measure. The Breslau Usual Provider of Care index is also an indicator of continuity of care, ranging from 0 to 1, where 1 represents continuity of care. The effect of telemedicine on continuity of care using the Breslau Usual Provider of Care measure will be calculated using difference-in-difference methodology. The estimate coefficient will be reported.
Time frame: Assessed at the quarter level for 3 years, data collected encompasses retrospective data from Q1 2019 to Q4 2021
Number of Unplanned Hospital Admissions From the ED
Unplanned hospital admissions from the ED will be obtained from claims data
Time frame: 60 days after the exposure to one of the comparator arms of clinic-level telemedicine used
Continuity of Care as Assessed by the Bice-Boxerman Continuity of Care Index
Continuity of Care as Assessed by the Bice-Boxerman Continuity of Care Index. The Bice-Boxerman Continuity of Care Index is also an indicator of continuity of care, ranging from 0 to 1, where 1 represents continuity of care. The effect of telemedicine on continuity of care using the Bice-Boxerman Continuity of care index will be calculated using difference-in-difference methodology. The estimate coefficient will be reported.
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Time frame: Assessed at the quarter level for 3 years, data collected encompasses retrospective data from Q1 2019 to Q4 2021
Number of Unplanned Hospital Admissions From the ED
Unplanned hospital admissions from the ED will be obtained from claims data
Time frame: 6 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Number of Unplanned Hospital Admissions From the ED
Unplanned hospital admissions from the ED will be obtained from claims data
Time frame: 12 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Number of Avoidable Emergency Department (ED) Admissions
Avoidable emergency department (ED) admissions will be obtained from claims data
Time frame: 60 days after the exposure to one of the comparator arms of clinic-level telemedicine used
Number of Avoidable Emergency Department (ED) Admissions
Avoidable emergency department (ED) admissions will be obtained from claims data
Time frame: 6 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Number of Avoidable Emergency Department (ED) Admissions
Avoidable emergency department (ED) admissions will be obtained from claims data
Time frame: 12 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Continuity of Care as Assessed by the Bice-Boxerman Continuity of Care Index
Continuity of care will be measured using the Bice-Boxerman Continuity of Care Index. The Bice-Boxerman continuity of care (COC) index reflects the relative share of all of a patient's visits during the year that are billed by distinct providers and/or practices. The index ranges from 0 to 1, where 0 indicates that each visit involved a different provider than all other visits, and 1 that all visits were billed by a single provider, representing continuity of care.
Time frame: 60 days after the exposure to one of the comparator arms of clinic-level telemedicine used
Continuity of Care as Assessed by the Bice-Boxerman Continuity of Care Index
Continuity of care will be measured using the Bice-Boxerman Continuity of Care Index. The Bice-Boxerman continuity of care (COC) index reflects the relative share of all of a patient's visits during the year that are billed by distinct providers and/or practices. The index ranges from 0 to 1, where 0 indicates that each visit involved a different provider than all other visits, and 1 that all visits were billed by a single provider, representing continuity of care.
Time frame: 6 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Continuity of Care as Assessed by the Bice-Boxerman Continuity of Care Index
Continuity of care will be measured using the Bice-Boxerman Continuity of Care Index. The Bice-Boxerman continuity of care (COC) index reflects the relative share of all of a patient's visits during the year that are billed by distinct providers and/or practices. The index ranges from 0 to 1, where 0 indicates that each visit involved a different provider than all other visits, and 1 that all visits were billed by a single provider, representing continuity of care.
Time frame: 12 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Continuity of Care as Assessed by the Breslau Usual Provider of Care Measure
Continuity of care as assessed by the Breslau Usual Provider of Care measure. The Breslau Usual Provider of Care index is also an indicator of continuity of care, ranging from 0 to 1, where 1 represents continuity of care.
Time frame: 60 days after the exposure to one of the comparator arms of clinic-level telemedicine used
Continuity of Care as Assessed by the Breslau Usual Provider of Care Measure
Continuity of care as assessed by the Breslau Usual Provider of Care measure. The Breslau Usual Provider of Care index is also an indicator of continuity of care, ranging from 0 to 1, where 1 represents continuity of care.
Time frame: 6 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Continuity of Care as Assessed by the Breslau Usual Provider of Care Measure
Continuity of care as assessed by the Breslau Usual Provider of Care measure. The Breslau Usual Provider of Care index is also an indicator of continuity of care, ranging from 0 to 1, where 1 represents continuity of care.
Time frame: 12 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Continuity of Care as Assessed by Attendance at Follow-up Appointment
Continuity of care as assessed by attendance at follow-up appointment.
Time frame: 30 days after the exposure to one of the comparator arms of clinic-level telemedicine used
Continuity of Care as Assessed by Attendance at Follow-up Appointment
Continuity of care as assessed by attendance at follow-up appointment.
Time frame: 60 days after the exposure to one of the comparator arms of clinic-level telemedicine used
Continuity of Care as Assessed by Attendance at Follow-up Appointment
Continuity of care as assessed by attendance at follow-up appointment.
Time frame: 6 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Continuity of Care as Assessed by Attendance at Follow-up Appointment
Continuity of care as assessed by attendance at follow-up appointment.
Time frame: 12 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Evidence of Controlled Disease as Indicated by as Indicated by the National Quality Forum (NQF 0059): Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
Evidence of controlled disease as indicated by as indicated by the National Quality Forum (NQF 0059): Diabetes: Hemoglobin A1c (HbA1c) Poor Control (\>9%), which is the percentage of patients 18 - 75 years of age with diabetes who had hemoglobin A1c \> 9.0% during the measurement period
Time frame: 30 days after the exposure to one of the comparator arms of clinic-level telemedicine used
Evidence of Controlled Disease as Indicated by as Indicated by the National Quality Forum (NQF 0059): Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
Evidence of controlled disease as indicated by as indicated by the National Quality Forum (NQF 0059): Diabetes: Hemoglobin A1c (HbA1c) Poor Control (\>9%), which is the percentage of patients 18 - 75 years of age with diabetes who had hemoglobin A1c \> 9.0% during the measurement period
Time frame: 60 days after the exposure to one of the comparator arms of clinic-level telemedicine used
Evidence of Controlled Disease as Indicated by as Indicated by the National Quality Forum (NQF 0059): Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
Evidence of controlled disease as indicated by as indicated by the National Quality Forum (NQF 0059): Diabetes: Hemoglobin A1c (HbA1c) Poor Control (\>9%), which is the percentage of patients 18 - 75 years of age with diabetes who had hemoglobin A1c \> 9.0% during the measurement period
Time frame: 6 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Evidence of Controlled Disease as Indicated by as Indicated by the National Quality Forum (NQF 0059): Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
Evidence of controlled disease as indicated by as indicated by the National Quality Forum (NQF 0059): Diabetes: Hemoglobin A1c (HbA1c) Poor Control (\>9%), which is the percentage of patients 18 - 75 years of age with diabetes who had hemoglobin A1c \> 9.0% during the measurement period
Time frame: 12 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Evidence of Controlled Disease as Indicated by as Indicated by the National Quality Forum (NQF 0018): Controlling High Blood Pressure
Evidence of controlled disease as indicated by as indicated by the National Quality Forum (NQF 0018): Controlling High Blood Pressure, which is the percentage of patients 18 - 85 with hypertension diagnosis and adequate control (\< 140/90 mmHg)
Time frame: 30 days after the exposure to one of the comparator arms of clinic-level telemedicine used
Evidence of Controlled Disease as Indicated by as Indicated by the National Quality Forum (NQF 0018): Controlling High Blood Pressure
Evidence of controlled disease as indicated by as indicated by the National Quality Forum (NQF 0018): Controlling High Blood Pressure, which is the percentage of patients 18 - 85 with hypertension diagnosis and adequate control (\< 140/90 mmHg)
Time frame: 60 days after the exposure to one of the comparator arms of clinic-level telemedicine used
Evidence of Controlled Disease as Indicated by as Indicated by the National Quality Forum (NQF 0018): Controlling High Blood Pressure
Evidence of controlled disease as indicated by as indicated by the National Quality Forum (NQF 0018): Controlling High Blood Pressure, which is the percentage of patients 18 - 85 with hypertension diagnosis and adequate control (\< 140/90 mmHg)
Time frame: 6 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Evidence of Controlled Disease as Indicated by as Indicated by the National Quality Forum (NQF 0018): Controlling High Blood Pressure
Evidence of controlled disease as indicated by as indicated by the National Quality Forum (NQF 0018): Controlling High Blood Pressure, which is the percentage of patients 18 - 85 with hypertension diagnosis and adequate control (\< 140/90 mmHg)
Time frame: 12 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Days at Home
Days per month not in hospital or institutional setting
Time frame: 30 days after the exposure to one of the comparator arms of clinic-level telemedicine used
Days at Home
Days per month not in hospital or institutional setting
Time frame: 60 days after the exposure to one of the comparator arms of clinic-level telemedicine used
Days at Home
Days per month not in hospital or institutional setting
Time frame: 6 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Days at Home
Days per month not in hospital or institutional setting
Time frame: 12 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Patient Experiences Based on the Patient Satisfaction Questionnaire (PSQ-18)
Patient experiences based on the Patient Satisfaction Questionnaire (PSQ-18), which is a 5-scale questionnaire including questions on patient satisfaction, communication quality with providers and accessibility/convenience of care.
Time frame: 12 months after the exposure to one of the comparator arms of clinic-level telemedicine used
Ease of Use and Access to Telemedicine Based on Telehealth Usability Questionnaire (TUQ)
For individuals who accessed a telemedicine visit, we will ask questions based on the validated Telehealth Usability Questionnaire (TUQ), including the ease of use and access to the telemedicine service, quality of the interaction with the provider, and satisfaction
Time frame: 12 months after the exposure to one of the comparator arms of clinic-level telemedicine used