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. 2024 May 2;3(6):100969.
doi: 10.1016/j.jacadv.2024.100969. eCollection 2024 Jun.

Comparison of Short-Term Health Care Utilization Between Telemedicine-Delivered vs In-Person Care Visits for Heart Failure

Scott D Casey  1   2   3 , Dana R Sax  1   2   4 , Dustin G Mark  2   4 , Jamal S Rana  1   5 , Matthew D Solomon  1   5 , Jie Huang  1   2 , Mary E Reed  1   2
Affiliations

Comparison of Short-Term Health Care Utilization Between Telemedicine-Delivered vs In-Person Care Visits for Heart Failure

Scott D Casey et al. JACC Adv. .

Abstract

Background: Patients with heart failure (HF) are a medically complex population with frequent hospitalizations. Downstream health care utilization following primary care delivered by telemedicine compared to in-person is unknown.

Objectives: The purpose of this study was to understand differences in return in-person visits, emergency department (ED) encounters, and hospitalizations following a telemedicine vs an in-person primary care visit for patients with HF seen for a HF-related complaint.

Methods: This was an observational study of all primary care visits for HF from January 1, 2022, to December 31, 2022, in an integrated health care delivery system. We compared 7-day in-person follow-up visits, ED visits, and hospitalizations (all-cause and HF-specific) by index visit type.

Results: We included 3,902 primary care visits with a primary diagnosis of HF. Most visits utilized telephone or video visits (58.4% total; 44.9% telephone, 13.5% video). After adjustment, telephone visits were associated with more in-person follow-up visits (6.14% vs 4.20%; adjusted OR: 1.08-2.21; P < 0.05) but fewer ED visits (6.12% vs 8.07%; adjusted OR: 0.55-0.97; P < 0.05) compared to in-person visits. Most hospitalized patients (74%) had an admitting diagnosis of HF. There was no difference between 7-day all-cause hospitalization following telephone or video visits compared to in-person visits.

Conclusions: Most patients used telemedicine to address HF-specific primary care concerns. Telephone visits were associated with slightly higher short-term in-person primary care follow-up but lower ED utilization. Overall, downstream ED visits and hospitalizations were low. Telephone and video visits appear to offer safe alternatives to in-person care for HF-related primary care and are a promising health care delivery strategy.

Keywords: heart failure; primary care; telemedicine.

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Conflict of interest statement

The project was supported by a grant (R01HS25189) from the Agency for Healthcare Research and Quality. Dr Casey has received funding from The Permanente Medical Group (TPMG) Delivery Science Fellowship Program and has nothing to disclose. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

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Graphical abstract
Central Illustration
Central Illustration
Adjusted 7-Day ED Encounters and Hospitalizations Following a Primary Care Visit for a HF-Related Complaint by Visit Modality ∗Indicates statistically significantly different compared to in-person visit comparison group. ED = emergency department; HF = heart failure.
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