View from the Patient Perspective: Mixed-Methods Analysis of Post-Discharge Virtual Visits in a Randomized Controlled Trial

Utilization of telemedicine to provide post-discharge care: A comparison of pre-pandemic vs. pandemic care

BACKGROUND

Due to the COVID-19 pandemic, post-discharge virtual visits transitioned from a novel intervention to standard practice. Our aim was to evaluate participation in and outcomes of virtual post-discharge visits in the early-pandemic timeframe.

METHODS

Pandemic cohort patients were compared to historical patients. Patient demographics, clinical information, and post-discharge 30-day hospital encounters were compared between groups.

RESULTS

The historical cohort included 563 patients and the pandemic cohort had 823 patients. There was no difference in 30-day hospital encounters between patients who completed a video vs. telephone visit in the pandemic cohort (3.8% vs. 7.6%, p = 0.11). There was a lower 30-day hospital encounter rate in pandemic video and telephone visits compared to similar historical sub-groups.

CONCLUSION

Expansion of virtual post-discharge visits to include all patients and telephone calls did not negatively impact rates of 30-day post-discharge hospital encounters. Offering telehealth options for post-discharge follow-up does not appear to have negative impact on healthcare utilization.

Impact of Digital Health upon the Surgical Patient Experience: The Patient as Consumer

The adoption of digital health services in surgical care delivery is changing the patient experience. The goal of patient-generated health data monitoring incorporated with patient-centered education and feedback is to optimally prepare patients for surgery and personalize postoperative care to improve outcomes that matter to both patients and surgeons. Challenges include the need for the adoption of new methods for implementation and evaluation and equitable application of surgical digital health interventions, with considerations for accessibility as well as the development of new diagnostics and decision support that include the needs and characteristics of all populations served.

Patient reported satisfaction levels with the use of telemedicine for general surgery-A systematic review of randomized control trials

Background

As healthcare continues to evolve in the wake of COVID-19 pandemic, surgeons are presented with the opportunity to integrate telemedicine into healthcare in tandem with in-person consultations. We aimed to perform a systematic review of randomized controlled trials to assess patient satisfaction with telemedicine interventions in general surgery.

Methods

A systematic review was performed in accordance to the PRISMA guidelines. Randomized control trials (RCTs) were included. The risk of bias 2.0 assessment was used to determine potential bias.

Results

In total, 11 prospective, randomized trials involving 1,598 patients (mean age: 49.1 years) were included. Overall 45.5% (5/11) of the trials compared videoconferencing or telephone follow up to traditional in person follow up. Three studies used smart technologies which include activity tracking devices in combination with a website and mobile application (27.3%). The other 3 interventions involved accelerated discharge on post operative day (POD) 1 with tele videoconferencing on POD 2, Post-operative daily text messages with education videos and video calling capability, and supportive text messages post-operatively. Telemedicine was shown to provide similar levels of patient satisfaction compared to controls in all 11 included RCTs.

Conclusion

Patient reported satisfaction with the use of telemedicine is similar to standard of care models in general surgery. With several shortcomings confounding the results in support of telemedicine, further experimentation with telemedicine interventions will likely improve patient reported satisfaction with using telemedicine for peroperative surgical care.

Demographic Disparity in Use of Telemedicine for Ambulatory General Surgical Consultation During the COVID-19 Pandemic: Analysis of the Initial Public Health Emergency and Second Phase Periods

BACKGROUND

Surgical patients with limited digital literacy may experience reduced telemedicine access. We investigated racial/ethnic and socioeconomic disparities in telemedicine compared with in-person surgical consultation during the coronavirus disease 2019 (COVID-19) pandemic.

STUDY DESIGN

Retrospective analysis of new visits within the Division of General & Gastrointestinal Surgery at an academic medical center occurring between March 24 through June 23, 2020 (Phase I, Massachusetts Public Health Emergency) and June 24 through December 31, 2020 (Phase II, relaxation of restrictions on healthcare operations) was performed. Visit modality (telemedicine/phone vs in-person) and demographic data were extracted. Bivariate analysis and multivariable logistic regression were performed to evaluate associations between patient characteristics and visit modality.

RESULTS

During Phase I, 347 in-person and 638 virtual visits were completed. Multivariable modeling demonstrated no significant differences in virtual compared with in-person visit use across racial/ethnic or insurance groups. Among patients using virtual visits, Latinx patients were less likely to have video compared with audio-only visits than White patients (OR, 0.46; 95% CI 0.22-0.96). Black race and insurance type were not significant predictors of video use. During Phase II, 2,922 in-person and 1,001 virtual visits were completed. Multivariable modeling demonstrated that Black patients (OR, 1.52; 95% CI 1.12-2.06) were more likely to have virtual visits than White patients. No significant differences were observed across insurance types. Among patients using virtual visits, race/ethnicity and insurance type were not significant predictors of video use.

CONCLUSION

Black patients used telemedicine platforms more often than White patients during the second phase of the COVID-19 pandemic. Virtual consultation may help increase access to surgical care among traditionally under-resourced populations.