The Role of Telehealth in COVID-19 Response (California)

The severity and contagion of the COVID-19 pandemic required a fast transition from in-person to telehealth medical visits to reduce exposure and prioritize the safety of patients and clinicians. This rapid transition greatly impacted outpatient services, showing a drastic shift in urgent care and a significant reduction in ambulatory care. Telehealth service providers with 24/7 urgent care services and national reach are uniquely positioned to rapidly identify and report key impacts the pandemic has had on the Nation’s healthcare system. In a current AHRQ-funded project (R01 HS026506), the research team developed a surveillance system to monitor prescribing practices for respiratory infections and generate evidence-based notifications through the electronic medical record. The same model can be employed to rapidly update and disseminate practice guidance for respiratory infections and ambulatory care-sensitive conditions. By understanding the validity of this newly generated data, further examination can be conducted to assess the response to and impact of the COVID-19 pandemic.

This research, using data from the country’s largest telehealth provider and claims from a large commercial payer, will examine the impact of the COVID-19 pandemic and telehealth on utilization, outcomes, disparities, and public health surveillance.

The specific aims of the research are as follows:

• Assess the validity and timeliness of telehealth information for prospective public health surveillance. 
• Assess the role of telehealth in responding to the primary impact of COVID-19. 
• Assess the role of telehealth in responding to the secondary impact of COVID-19. 

In the first aim, the researchers will compare home testing to laboratory results, assessing the surveillance value of cases reported by patients and their symptoms to actual test results. In the second aim, the researchers will use the two databases to examine how treatment and outcomes of patients who were not hospitalized varied in regard to COVID-19 and influenza like illnesses. This will be done both on the physician level, in terms of diagnostic and treatment patterns, as well as on differences between telehealth and in-person outpatient care. In the third aim, the researchers will assess the secondary impact of COVID-19 (i.e., the impact from the unprecedented reduction in ambulatory care). They will look to how well telehealth has been able to fill the gap in ambulatory care and examine changes in care gaps using quality indicators for AHRQ ambulatory care-sensitive conditions. These conditions, such as diabetes and asthma, are those for which inpatient care should be able to be avoided with robust outpatient management. In addition, they will compare indicators for issues that can be entirely managed via telehealth versus those that might be enhanced by triage, determine those individuals who are not able to be cared for virtually, and direct them to earlier in-person care than they might have otherwise sought. Finally, they will determine the impact of COVID-19 on known disparities in care gaps and outcomes.

This research will elucidate whether telehealth data may be used as public health surveillance data and improve understanding of the response to the pandemic and its impact on ambulatory care-sensitive conditions.