Visit and Between-Visit Interaction Frequency Before and After COVID-19 Telehealth Implementation

Area of Science:

• Health Services Research
• Digital Health
• Health Equity

Background:

• The COVID-19 public health emergency (PHE) rapidly accelerated telehealth adoption, significantly altering patient-clinical team interactions.
• Previous research has primarily focused on billed patient-clinician visits, potentially overlooking other crucial care delivery components like interactions with non-billing team members or between-visit communications.

Purpose of the Study:

• To analyze changes in the rates of in-person visits, telehealth visits, and between-visit interactions (e.g., phone calls, patient portal messages) over time.
• To examine these changes in relation to key patient characteristics, including age, race/ethnicity, language, and socioeconomic status, during the PHE.

Main Methods:

• A retrospective cohort study analyzed encounters for adult patients with diabetes from April 2019 to March 2021 across two urban academic and safety-net health care systems.
• Interrupted time-series analysis was employed to evaluate trends in total encounters, visits with any health care team member, billed clinician visits, and between-visit interactions across three periods: pre-PHE, strict shelter-in-place, and hybrid-PHE.

Main Results:

• Total patient encounters increased during the hybrid-PHE period, mainly driven by a rise in between-visit interactions, while the rate of visits remained stable.
• Fewer disparities in visit utilization were observed across patient characteristics during the hybrid-PHE period compared to pre-PHE.
• However, pre-existing disparities in between-visit interactions persisted, with certain racial/ethnic and language groups (e.g., Asian/Chinese-speaking patients at SFHN) experiencing fewer interactions compared to White/English-speaking patients.

Conclusions:

• The growth in patient-clinician encounters during the PHE was sustained by between-visit interactions, extending beyond traditional billed visits.
• Observed persistent disparities in between-visit interactions among different patient groups suggest potential inequities in care access and communication.
• Further research is needed to understand the impact of these evolving care utilization patterns, particularly between-visit interactions, on patient outcomes and health care team workload.