Healthcare utilization in a cohort receiving chronic disease specialty care by video telemedicine compared to propensity-matched adults not using telemedicine

Abstract

Introduction

Telemedicine use has undergone rapid transformation in recent years. We designed this study to evaluate factors associated with telemedicine use and modality and the association with telemedicine use and healthcare utilization in a post-pandemic period.

Methods

This observational study included four regions of the Alaska Tribal Health System. We used electronic health record data to evaluate a cohort of adults who had chronic disease specialty care visits, with or without telemedicine, between July 1, 2021 to December 31, 2021 for factors associated with telemedicine use and modality. We then evaluated the association between telemedicine use and healthcare utilization in 2022. We used propensity score matching to improve covariate balance between adults who had used telemedicine or not, and then estimated the effect of telemedicine on outcomes (inpatient hospitalizations, outpatient visits, and emergency department visits) using multivariable models.

Results

Adults who used telemedicine were slightly older, had more chronic conditions and clinic visits, and resided in different regions compared to those who did not, with differences also observed between telemedicine modalities. The incident rate ratio for inpatient visits (1.16, p = 0.28), outpatient visits (1.15, p = 0.13), and emergency department visits (1.12, p = 0.36) were higher but not statistically significant for adults using telemedicine when compared to individuals not using telemedicine.

Discussion

We found a non-significant association of higher rates of inpatient, outpatient, and emergency department visits in people who used telemedicine compared to propensity-matched “controls.” These findings should be considered in context of potential benefits of telemedicine and patient preference.