Virtual vs In-Person Neurologic Ambulatory Care: A Case-Control Study of Subsequent Health Care Utilization

Implementation of telemedicine expanded options for outpatient neurology care. It remains uncertain which new neurology patients can be appropriately evaluated virtually. We compared subsequent health care utilization after virtual vs in-person new patient neurology visits across 3 academic medical centers.

We conducted a retrospective multicenter cohort study of adults with a new outpatient neurology visit from September 2020 through December 2021 using the Vizient Clinical Data Base and Clinical Practice Solutions Center databases. Virtual and in-person patients were matched 1:1 using propensity scores incorporating demographics, clinical characteristics, time period, and previous health care utilization. Outcomes were analyzed overall and stratified by neurologic chief complaint category and institution. We compared rates of subsequent neurologic clinic follow-up, emergency department (ED) visits, and hospitalizations after virtual and in-person encounters. Testing and all-cause ED visits/hospitalizations were also assessed.

We identified 10,428 virtual and 36,767 in-person neurology new outpatient visits. After propensity score matching, 8,202 virtual visits were matched to 8,202 in-person visits. Neurology follow-up within 90 days did not differ between virtual and in-person visits (24.6% vs 23.7%, p = 0.18). Thirty-day neurology clinic follow-up was slightly lower after virtual visits, whereas follow-up at 6 months and 1 year was similar between groups. Neurologic ED visits and hospitalizations within 90 days were similar (0.9% vs 0.8%, p = 0.23 and 1.8% vs 1.7%, p = 0.47, respectively). All-cause ED visits and hospitalizations within 90 days were also comparable (1.8% vs 1.7%, p = 0.59 and 2.2% vs 1.8%, p = 0.13, respectively). Analyses by chief complaint found that 90-day follow-up was higher after in-person visits for dementia, whereas 30- and 90-day follow-up was higher after virtual visits for Parkinson disease and multiple sclerosis, and 90-day follow-up was higher after virtual visits for headache. Testing was more frequent after in-person visits for certain chief complaints.

In this propensity score-matched multicenter cohort, new neurology patients seen virtually had similar downstream utilization as those seen in-person, including comparable 90-day follow-up and similar neurologic and all-cause ED visits and hospitalizations. Although follow-up varied modestly by chief complaint and testing was more frequent after some in-person visits, no major differences emerged overall.