Patient Choice of Telemedicine Encounters (California)

Project Details - Ongoing

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Summary:

American patients spend an average of 2 hours, including travel and wait time, for a 20-minute office visit, totaling $50 billion in opportunity costs. Real-time patient-provider video and telephone telemedicine visits are an interactive health information technology (IT) tool with the potential to engage patients. Telemedicine can offer patients the choice to access a provider visit without arranging transportation, time off from work or caregiving, or spending time in a waiting room. While patient-physician telemedicine has historically been used in narrow clinical situations such as specialty consultations or rural patients, direct real-time patient-physician video visits for a broad patient population has only recently become feasible. Because of this, there is a wide evidence gap on the quality and safety of telemedicine use in ambulatory care, including missed diagnoses and screenings, medication errors, and insufficient patient monitoring.

This project will focus on patient-initiated primary care telemedicine encounters through the patient portal of an integrated healthcare delivery system. It will examine the quality and safety impacts of real-time patient-provider telemedicine visits and interactive health IT tools with the potential to engage patients through convenient healthcare access.

The specific aims of the project are as follows:

  • Examine patient clinical concerns and access measures associated with the choice of a telemedicine encounter compared with in-person encounters. 
  • Evaluate the quality and safety of the telemedicine encounters through guideline-recommended healthcare processes, followup visits, and events. 

Researchers will examine a sample of patients over a 5-year period of patient-scheduled telemedicine appointments and compare with patient-scheduled in-person visits. Using patient surveys and key informant interviews, researchers will examine the experiences of telemedicine users and decision makers, including technology usability, convenience, and patient-reported outcomes. This novel telemedicine access is fully integrated with comprehensive electronic health records.

Investigators will test the hypotheses that care processes and short-term event rates for patient-initiated telemedicine encounters will not be worse than for patient-initiated in-person visits. They will also account for patient engagement, recent changes in health status, case-mix, cost-sharing for in-person visits, internet access, and patient demographic and socio-economic characteristics. By examining an early adopter of the technologies, and a large and diverse patient population, this project has the potential to provide timely evidence to inform emerging telehealth policies, technology adoption decisions, and real-world use by patients and clinicians.

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Why Do Patients Choose Telemedicine for Primary Care? The Untapped Potential of Telemedicine for Primary Care

Significance and Potential Impact:

This research will provide evidence to inform emerging telehealth policies including reimbursement, technology adoption decisions, and real-world use by patients and providers.

Why do patients choose telemedicine as an alternative to an in-person primary care visit?

Telemedicine has long been used to provide access to specialty care, especially for patients living in rural areas, but its use to benefit primary care patients is less understood. In addition, little is known about its impact on quality and safety, such as on diagnoses, medications, or patient monitoring.

“As a health services researcher, this was an exciting opportunity to research technology and how it affects patients’ choices, what kinds of clinical concerns patients choose telemedicine for, and what its best uses are for in primary care.”
- Dr. Mary Reed

In 2016, Kaiser Permanente Northern California began offering patient-initiated primary care telemedicine visits. All patients self-scheduling appointments with a primary care provider through their patient portal were able to choose from a traditional in-person visit or a telemedicine visit conducted by video or telephone. Mary Reed, DrPH, from the Kaiser Permanente Northern California Division of Research, wants to know who chooses telemedicine and for what health issues. Dr. Reed and her team are prospectively comparing outcomes for patients who choose telemedicine versus an in-person primary care visit from 2016 to 2020. The research team will compare patient demographics, their reported experiences, and clinical characteristics, with the goal of identifying patterns or reasons why patients choose telemedicine versus an in-person visit. In addition, the team will evaluate whether telemedicine affects the safety and quality of primary care by examining recommended health care processes, in-person followup care, and increased ED visits and hospital admissions between those who choose telemedicine visits compared with those who choose an in-person visit.

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