Telehealth use during the early COVID-19 public health emergency and subsequent health care costs and utilization.
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ABSTRACT:
SUBMITTER: Lee JS
PROVIDER: S-EPMC10895996 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Telehealth use during the early COVID-19 public health emergency and subsequent health care costs and utilization.
Lee Jun Soo JS Bhatt Ami A Pollack Lisa M LM Jackson Sandra L SL Chang Ji Eun JE Tong Xin X Luo Feijun F
Health affairs scholar 20240101 1
Telehealth utilization increased during the COVID-19 pandemic, yet few studies have documented associations of telehealth use with subsequent medical costs and health care utilization. We examined associations of telehealth use during the early COVID-19 public health emergency (March-June 2020) with subsequent total medical costs and health care utilization among people with heart disease (HD). We created a longitudinal cohort of individuals with HD using MarketScan Commercial Claims data (2018- ...[more]
Similar Datasets
Project description:Determine the association of poor multidimensional sleep health with health-care costs and utilization. We linked 1,459 community-dwelling women (mean age 83.6 years) participating in the Study of Osteoporotic Fractures Year 16 visit (2002-2004) with their Medicare claims. Five dimensions of sleep health (satisfaction, daytime sleepiness, timing, latency, and duration) were assessed by self-report. The number of impaired dimensions was expressed as a score (range 0-5). Total direct health-care costs and utilization were ascertained during the subsequent 36 months. Mean (SD) total health-care costs/year (2017 dollars) increased in a graded manner across the sleep health score ranging from $10,745 ($15,795) among women with no impairment to up to $15,332 ($22,810) in women with impairment in three to five dimensions (p = 0.01). After adjustment for age, race, and enrollment site, women with impairment in three to five dimensions vs. no impairment had greater mean total costs (cost ratio [CR] 1.34 [95% CI = 1.13 to 1.60]) and appeared to be at higher risk of hospitalization (odds ratio (OR) 1.31 [95% CI = 0.96 to 1.81]). After further accounting for number of medical conditions, functional limitations, and depressive symptoms, impairment in three to five sleep health dimensions was not associated with total costs (CR 1.02 [95% CI = 0.86 to 1.22]) or hospitalization (OR 0.91 [95% CI = 0.65 to 1.28]). Poor multidimensional sleep health was not related to outpatient costs or risk of skilled nursing facility stay. Older women with poor sleep health have higher subsequent total health-care costs largely attributable to their greater burden of medical conditions, functional limitations, and depressive symptoms.
| S-EPMC7017952 | biostudies-literature
Project description:BackgroundThe emergence of coronavirus disease 2019 (COVID-19) forced many eye care providers to implement telehealth services while in-person visits were reserved for essential and/or emergency eye care.ObjectiveThis study documents how an optometry group successfully implemented telehealth to care for patients during the outbreak of the COVID-19 pandemic in the United States.DesignRetrospective, comparative case series.MethodsRecords were reviewed for patients seen in an academic optometry clinic from 23 March through 7 April 2020, the period of the Massachusetts stay-at-home advisory issued in response to COVID-19. Patients who completed telehealth visits were compared with those who received in-person care. Services delivered by telehealth included a check of symptoms, medication refills, health education, and assurance of future follow up. The study took into account the reason for each visit, as well as the rate of scheduled and completed follow-up appointments. Patient satisfaction with in-person care was evaluated by Press Ganey patient experience surveys.ResultsOut of 855 patients scheduled, 421 patients completed telehealth encounters (49%), and 46 patients completed in-clinic visits (5.4%). A further 272 patients canceled appointments (32%), 123 patients were unable to be contacted (14%), and 8 patients declined care offered by telehealth (0.94%). Most patients who were cared for by telehealth returned to see optometrists (88%). By contrast, most patients who required in-person visits during this period were subsequently seen by ophthalmologists (58%, p < 0.001). Patient satisfaction remained high for in-person visits that took place during the COVID-19-related emergency, with improvements noted in patient satisfaction regarding 'information about delays' (47 % versus 100%, p = 0.007) and 'concern for questions or worries' (76% versus 100%, p = 0.037) compared with the same period 1 year prior.ConclusionOptometrists rapidly embraced telehealth to deliver eye care to their patients during the COVID-19 public health emergency. Most eye issues were able to be addressed through telehealth; urgent eye problems were triaged and referred to the optometry clinic, when appropriate.
| S-EPMC9527121 | biostudies-literature
Project description:ImportanceTelehealth services expanded rapidly during the COVID-19 public health emergency (PHE).ObjectiveTo evaluate changes in availability of telehealth services at outpatient mental health treatment facilities (MHTFs) throughout the US during and after the COVID-19 PHE.Design, setting, and participantsIn this cohort study, callers posing as prospective clients contacted a random sample of 1404 MHTFs drawn from the Substance Abuse and Mental Health Services Administration's Behavioral Health Treatment Locator from December 2022 to March 2023 (wave 1 [W1]; during PHE). From September to November 2023 (wave 2 [W2]; after PHE), callers recontacted W1 participants. Analyses were conducted in January 2024.Main outcomes and measuresCallers inquired whether MHTFs offered telehealth (yes vs no), and, if yes, whether they offered (1) audio-only telehealth (vs audio and video); (2) telehealth for therapy, medication management, and/or diagnostic services; and (3) telehealth for comorbid alcohol use disorder (AUD). Sustainers (offered telehealth in both waves), late adopters (did not offer telehealth in W1 but did in W2), nonadopters (did not offer telehealth in W1 or W2), and discontinuers (offered telehealth in W1 but not W2) were all compared.ResultsDuring W2, 1001 MHTFs (86.1%) were successfully recontacted. A total of 713 (71.2%) were located in a metropolitan county, 151 (15.1%) were publicly operated, and 935 (93.4%) accepted Medicaid as payment. The percentage offering telehealth declined from 799 (81.6%) to 765 (79.0%) (odds ratio [OR], 0.84; 95% CI, 0.72-1.00; P < .05). Among MHTFs offering telehealth, a smaller percentage in W2 offered audio-only telehealth (369 [49.3%] vs 244 [34.1%]; OR, 0.53; 95% CI, 0.44-0.64; P < .001) and telehealth for comorbid AUD (559 [76.3%] vs 457 [66.5%]; OR, 0.62; 95% CI, 0.50-0.76; P < .001) compared with W1. In W2, MHTFs were more likely to report telehealth was only available under certain conditions for therapy (141 facilities [18.0%] vs 276 [36.4%]; OR, 2.62; 95% CI, 1.10-3.26; P < .001) and medication management (216 facilities [28.0%] vs 304 [41.3%]; OR, 1.81; 95% CI, 1.48-2.21; P < .001). A total of 684 MHTFs (72.0%) constituted sustainers, 94 (9.9%) were discontinuers, 106 (11.2%) were nonadopters, and 66 (7.0%) were late adopters. Compared with sustainers, discontinuers were less likely to be private for-profit (adjusted OR [aOR], 0.28; 95% CI, 0.11-0.68) or private not-for-profit (aOR, 0.26; 95% CI, 0.14-0.48) after adjustment for facility and area characteristics.Conclusions and relevanceBased on this longitudinal cohort study of 1001 MHTFs, telehealth availability has declined since the PHE end with respect to scope and modality of services, suggesting targeted policies may be necessary to sustain telehealth access.
| S-EPMC11238022 | biostudies-literature
Project description:BackgroundDespite expanded access to telehealth services for Medicare beneficiaries in nursing homes (NHs) during the COVID-19 public health emergency, information on physicians' perspectives on the feasibility and challenges of telehealth provision for NH residents is lacking.ObjectiveTo examine physicians' perspectives on the appropriateness and challenges of providing telehealth in NHs.ParticipantsMedical directors or attending physicians in NHs.ApproachWe conducted 35 semistructured interviews with members of the American Medical Directors Association from January 18 through January 29, 2021. Outcomes of the thematic analysis reflected perspectives of physicians experienced in NH care on telehealth use.Main measuresThe extent to which participants used telehealth in NHs, the perceived value of telehealth for NH residents, and barriers to telehealth provision.Key resultsParticipants included 7 (20.0%) internists, 8 (22.9%) family physicians, and 18 (51.4%) geriatricians. Five common themes emerged: (1) direct care is needed to adequately care for residents in NHs; (2) telehealth may allow physicians to reach NH residents more flexibly during offsite hours and other scenarios when physicians cannot easily reach patients; (3) NH staff and other organizational resources are critical to the success of telehealth, but staff time is a major barrier to telehealth provision; (4) appropriateness of telehealth in NHs may be limited to certain resident populations and/or services; (5) conflicting views about whether telehealth use will be sustained over time in NHs. Subthemes included the role of resident-physician relationships in facilitating telehealth and the appropriateness of telehealth for residents with cognitive impairment.ConclusionsParticipants had mixed views on the effectiveness of telehealth in NHs. Staff resources to facilitate telehealth and the limitations of telehealth for NH residents were the most raised issues. These findings suggest that physicians in NHs may not view telehealth as a suitable substitute for most in-person services.
| S-EPMC10010241 | biostudies-literature
Project description:BackgroundBroader primary care practice range of services (ROS), defined as the diversity of professional services delivered, is associated with lower utilization. ROS provided by individual primary care physicians (PCPs) varies considerably with unclear implications for patients.ObjectivesCreate a PCP-ROS measure covering six categories of outpatient services, including expanded codes for mental health counseling services and point of care ultrasound (POCUS) technology in physician offices. Determine whether PCP-ROS is associated with total Medicare expenditures, inpatient admissions, acute hospital utilization (AHU), and emergency department (ED) visits. Examine physician and practice characteristics associated with PCP-ROS.DesignRetrospective cohort study.Participants4,569,711 Medicare fee-for-service beneficiaries and 27,008 PCPs observed during the evaluation of the Comprehensive Primary Care Plus (CPC +) initiative.MeasurementsPCP-ROS, hospitalizations, AHU (includes observation stays as well as inpatient admissions), ED visits, and total Medicare expenditures.ResultsPhysicians varied substantially in the range of services provided. Broader PCP-ROS was significantly, independently associated with 1 - 3% lower Medicare expenditures (p ≤ 0.01), inpatient admissions (p ≤ 0.027), AHU (p ≤ 0.025), and ED visit rates (p ≤ 0.000). PCP-ROS score was associated with improved patient outcomes, independent of physician provision of procedures (such as laceration repair or skin excisions). Physicians in practice sites affiliated with a hospital or health system had narrower PCP-ROS than independent physicians by 0.3 to 0.4 (p < 0.001). Internal medicine specialty was associated with narrower PCP-ROS than family medicine by 0.3 (p < 0.001).ConclusionsPatients cared for by primary care physicians who provide a broader range of services subsequently experience lower acute care utilization and expenditures than do those cared for by physicians with narrower ROS. Practice leaders and professional associations should consider how best to ensure that primary care physicians efficiently and effectively provide the office-based professional services most needed by their patients.
| S-EPMC10682337 | biostudies-literature
Project description:ObjectiveTo evaluate the effects of early pregnancy loss on subsequent health care use and costs.Data sourcesLinked administrative health databases from Manitoba, Canada.Study designThis was a population-based cohort study. The exposure of interest was first recorded ectopic pregnancy or miscarriage (EPM). Outcomes included visits to all ambulatory care providers, family physicians (FPs), specialists, and hospitals, as well as the costs associated with these visits. We also assessed the impact of EPM on a global measure of health service utilization and the incidence and costs of psychotropic medications.Data collection/extraction methodsWe identified women who experienced their first recorded loss (EPM) from 2003-2012 and created a propensity score model to match these women to women who experienced a live birth, with outcome measures available through 31 December 2014. We used a difference in differences approach with multivariable negative binomial models and generalized estimating equations (GEE) to assess the impact of EPM on the aforementioned health care utilization indicators.Principal findingsEPM was associated with a short-term increase in visits to, and costs associated with, certain ambulatory care providers. These findings were driven in large part by increased visits/costs to FPs (rate difference [RD]: $19.92 [95% CI: $16.33, $23.51]) and obstetrician-gynecologists (OB-GYNs) (RD $9.41 [95% CI: $8.42, $10.40]) in the year immediately following the loss, excluding care associated with the loss itself. We also detected an increase in hospital stays and costs and a decrease in the use of psychotropic medications relative to matched controls.ConclusionPregnancy loss may lead to subsequent increases in certain types of health care utilization. While the absolute costs associated with post-EPM care are relatively small, the observed patterns of service utilization are informative for providers and policy makers seeking to support women following a loss.
| S-EPMC9264463 | biostudies-literature
Project description:ObjectivesKawasaki disease (KD) is a common childhood vasculitis with increasing incidence in Canada. Acute KD hospitalizations are associated with high health care costs. However, there is minimal health care utilization data following initial hospitalization. Our objective was to determine rates of health care utilization and costs following KD diagnosis.MethodsWe used population-based health administrative databases to identify all children (0 to 18 years) hospitalized for KD in Ontario between 1995 and 2018. Each case was matched to 100 nonexposed comparators by age, sex, and index year. Follow-up continued until death or March 2019. Our primary outcomes were rates of hospitalization, emergency department (ED), and outpatient physician visits. Our secondary outcomes were sector-specific and total health care costs.ResultsWe compared 4,597 KD cases to 459,700 matched comparators. KD cases had higher rates of hospitalization (adjusted rate ratio 2.07, 95%CI 2.00 to 2.15), outpatient visits (1.30, 95%CI 1.28 to 1.33), and ED visits (1.22, 95%CI 1.18 to 1.26) throughout follow-up. Within 1 year post-discharge, 717 (15.6%) KD cases were re-hospitalized, 4,587 (99.8%) had ≥1 outpatient physician visit and 1,695 (45.5%) had ≥1 ED visit. KD cases had higher composite health care costs post-discharge (e.g., median cost within 1 year: $2466 CAD [KD cases] versus $234 [comparators]). Total health care costs for KD cases, respectively, were $13.9 million within 1 year post-discharge and $54.8 million throughout follow-up (versus $2.2 million and $23.9 million for an equivalent number of comparators).ConclusionsFollowing diagnosis, KD cases had higher rates of health care utilization and costs versus nonexposed children. The rising incidence and costs associated with KD could place a significant burden on health care systems.
| S-EPMC9191915 | biostudies-literature
Project description:ObjectiveThe aim of this study was to examine the association between the length of time between an emergency department (ED) visit and the subsequent initiation of physical therapist intervention for low back pain (LBP) on 1-year LBP-related health care utilization (ie, surgery, advanced imaging, injections, long-term opioid use, ED visits) and costs.MethodsThis retrospective cohort study focused on individuals who consulted the ED for an initial visit for LBP. Claims from a single statewide, all-payers database were used. LBP-related health care use and costs for the 12 months after the ED visit were extracted. Poisson and general linear models weighted with inverse probability treatment weights were used to compare the outcomes of patients who attended physical therapy early or delayed after the ED visit.ResultsCompared with the delayed physical therapy group (n = 94), the early physical therapy group (n = 171) had a lower risk of receiving lumbar surgery (relative risk [RR] = 0.47, 95% CI = 0.26-0.86) and advanced imaging (RR = 0.72, 95% CI = 0.55-0.95), and they were less likely to have long-term opioid use (RR = 0.45, 95% CI = 0.28-0.76). The early physical therapy group incurred lower costs (mean = $3,806, 95% CI = $1,998-$4,184) than those in the delayed physical therapy group (mean = $8,689, 95% CI = $4,653-$12,727).ConclusionEarly physical therapy following an ED visit was associated with a reduced risk of using some types of health care and reduced health care costs in the 12 months following the ED visit.Impact statementThe ED is an entry point into the health care system for patients with LBP. Until now, the impact of the length of time between an ED visit and physical therapy for LBP has not been well understood. This study shows that swift initiation of physical therapy following an ED visit for LBP is associated with lower LBP-related health utilization for some important outcomes and lower LBP-related health care costs.
| S-EPMC7530572 | biostudies-literature
Project description:BackgroundLyme disease is the most frequently reported vector borne infection in the United States. The Centers for Disease Control have estimated that approximately 10% to 20% of individuals may experience Post-Treatment Lyme Disease Syndrome - a set of symptoms including fatigue, musculoskeletal pain, and neurocognitive complaints that persist after initial antibiotic treatment of Lyme disease. Little is known about the impact of Lyme disease or post-treatment Lyme disease symptoms (PTLDS) on health care costs and utilization in the United States.Objectives1) to examine the impact of Lyme disease on health care costs and utilization, 2) to understand the relationship between Lyme disease and the probability of developing PTLDS, 3) to understand how PTLDS may impact health care costs and utilization.MethodsThis study utilizes retrospective data on medical claims and member enrollment for persons aged 0-64 years who were enrolled in commercial health insurance plans in the United States between 2006-2010. 52,795 individuals treated for Lyme disease were compared to 263,975 matched controls with no evidence of Lyme disease exposure.ResultsLyme disease is associated with $2,968 higher total health care costs (95% CI: 2,807-3,128, p<.001) and 87% more outpatient visits (95% CI: 86%-89%, p<.001) over a 12-month period, and is associated with 4.77 times greater odds of having any PTLDS-related diagnosis, as compared to controls (95% CI: 4.67-4.87, p<.001). Among those with Lyme disease, having one or more PTLDS-related diagnosis is associated with $3,798 higher total health care costs (95% CI: 3,542-4,055, p<.001) and 66% more outpatient visits (95% CI: 64%-69%, p<.001) over a 12-month period, relative to those with no PTLDS-related diagnoses.ConclusionsLyme disease is associated with increased costs above what would be expected for an easy to treat infection. The presence of PTLDS-related diagnoses after treatment is associated with significant health care costs and utilization.
| S-EPMC4317177 | biostudies-literature
Project description:ObjectiveThe coronavirus disease 2019 pandemic has presented emergency departments (EDs) with many challenges to address the acute care needs of patients. Many EDs have leveraged telehealth to innovatively respond to these challenges. This review describes the landscape of telehealth initiatives in emergency care that have been described during the coronavirus disease 2019 pandemic.MethodsWe conducted a comprehensive, systematic review of the literature using PubMed, supplemented by a review of the gray literature (ie, non-peer reviewed), with input from subject matter experts to identify telehealth initiatives in emergency care during coronavirus disease 2019. We categorized types of telehealth use based on purpose and user characteristics.ResultsWe included 27 papers from our review of the medical literature and another 8 sources from gray literature review. The vast majority of studies (32/35) were descriptive in nature, with the additional inclusion of 2 cohort studies and one randomized clinical trial. There were 5 categories of ED telehealth use during the pandemic: (1) pre-ED evaluation and screening, (2) within ED (including as a means of limiting staff and patient exposure and facilitating consultation with specialists), (3) post-ED discharge monitoring and treatment, (4) educating trainees and health care workers, and (5) coordinating resources and patient care.ConclusionTelehealth has been used in a variety of manners during the coronavirus disease 2019 pandemic, enabling innovation in emergency care delivery. The findings from this study can be used by institutions to consider how telehealth may address challenges in emergency care during the coronavirus disease 2019 pandemic and beyond. Because few studies included cost data and given the variability in institutional resources, how organizations implement telehealth programs will likely vary. Future work should further explore barriers and facilitators of innovation, and the impact on care delivery and patient outcomes.
| S-EPMC8087945 | biostudies-literature