Telemedicine visits during the COVID-19 pandemic were associated with lower use of imaging compared with in-person medical visits, according to a Harvey L. Neiman Health Policy Institute (HPI) report published July 16 in the Journal of the American College of Radiology (JACR).
The study evaluated differences in imaging utilization in telemedicine and in-person visits using a large national dataset and matching corresponding visit types based on patient, provider, and visit characteristics.
“We found that diagnostic imaging was nearly 30% less likely to occur following a telemedicine visit compared to an in-person visit,” said lead author YoonKyung Chung, PhD, principal researcher at the Neiman HPI, in a statement.
The COVID-19 pandemic resulted in rapid growth in the use of telemedicine, but the impact of telemedicine on diagnostic imaging overall has not been thoroughly explored. Additionally, there has been little research conducted on whether the imaging ordered in virtual settings is appropriate or what impact it may have on patient outcomes.
To address the knowledge gap, Chung's group conducted a study that evaluated the frequency of imaging utilization in telemedicine visits using data from Optum’s deidentified Clinformatics Datamart database, which included information from 23.4 million office visits conducted by more than 570,000 clinicians for 6.7 million patients during 2021. They identified all outpatient visits in which no other medical procedures were performed during the visit and were unrelated to COVID-19 infection. The group then included in the study only visits for patients who had been continuously enrolled with their practitioner both during the 12 months preceding and four months after the initial, or "index" visit.
The team classified the index visits into two groups: telemedicine and in-person office visits, matching telemedicine visits with in-person office encounters with similar characteristics (age, sex, race/ethnicity, census region of residence, private insurance status, and Charlson comorbidity index). The group used the percentage of rural population in a patient’s state of residence as a proxy for rurality and included percentage share of telemedicine visits to account for differences in telemedicine policies across states.
Of the database’s 23.4 million visits during 2021, 10% were coded as telemedicine visits. The group reported that telemedicine visits were less likely to be for a new patient (5.5% vs. 13.6% for in-person visits) and were more likely to be lower in acuity. They were more frequent for psychiatric care (19.7% for telemedicine and 3% for in-person) and were less frequent for providers who also provided imaging care (27.6% for telemedicine and 50.7% for in-person). Telemedicine visits were more common among those who were commercially insured (55.5% telemedicine; 36.4% in-person).
The seven-day postvisit imaging rate was 2.4% lower among telemedicine visits, resulting in a 29.7% relative difference in utilization rate after a telemedicine visit compared to an in-person visit. The results for 14- and 30-day postvisit imaging rates were similar, with 21.7% and 13.9% lower rates after a telemedicine visit compared with an in-person visit, respectively.
When postvisit imaging was restricted to diagnosis-relevant imaging studies occurring before the next visit, telemedicine visits had a 51.3% lower imaging rate compared to matching in-person visits.
The investigators urged future research focused on exploring the appropriateness of imaging studies ordered during telemedicine visits, as well as differences in adherence to orders in comparison to in-person visits.
Read the study here.
