Comparison of Periodic In-person ID Care to Daily Tele-ID Care at a Community Hospital

Access to infectious diseases (ID) specialists is absent in most US counties. Remote access to ID specialists via telemedicine is a potential alternative to in-person ID care, although comparative data are lacking. Armstrong Center for Medicine and Health, a 164-bed community hospital located in Armstrong County, Pennsylvania, that historically had periodic access to an in-person ID specialist every third business day established daily Tele-ID services in April 2020. We compared outcomes between periodic in-person ID care and daily Tele-ID care.

We performed a retrospective chart review comparing the outcomes of 100 patients seen via periodic in-person ID care from January 2019 to November 2019 versus 100 patients seen via daily Tele-ID care provided through live audio-video telemedicine visits and electronic consults (e-consults) from May 2020 to August 2020.

The daily Tele-ID care group had significantly higher Charlson Comorbidity Index scores (5.3 vs 4.5, P = .047), shorter length of stay (7.5 vs 9.08 days, P = .003), were less likely to be discharged on intravenous antibiotics (34% vs 51%, P = .007), and had more frequent discharges on oral antibiotics (39% vs 23%, P = .014; Table 2). There were no significant differences in the rates of transfer to tertiary care facilities (13% vs 14%, P = .84) or in-hospital mortality (2% vs 2%). The 30-day readmission rate was higher for the daily Tele-ID care group (11% vs 1%, P < .01); however, only 1 readmission was ID-related (Clostridioides difficile infection). The diversity of ID diagnoses made between the periodic in-person ID care and daily Tele-ID care groups was similar, except for increased rates of tickborne illnesses diagnosed via daily Tele-ID care (Figure 1). There was greater utilization of daily Tele-ID care compared to periodic in-person ID care.

A Tele-ID service with daily availability increased the utilization of ID care at a community hospital. Despite higher Charlson Comorbidity Index scores in Tele-ID patients, length of stay was shorter and discharge on intravenous antibiotics was less frequent with no statistically significant difference in ID-related readmissions or in-hospital mortality. These findings support daily Tele-ID care as a potential solution where access to ID expertise is limited.