Comparison of Quality Performance Measures for Patients Receiving In-Person vs Telemedicine Primary Care in a Large Integrated Health System

• Published in: JAMA network open 2022-09, Vol.5 (9), p.e2233267-e2233267
• Main Authors: Baughman, Derek J., Jabbarpour, Yalda, Westfall, John M., Jetty, Anuradha, Zain, Areeba, Baughman, Kathryn, Pollak, Brian, Waheed, Abdul
• Format: Article
• Language: English
• Subjects: Cancer; Cohort analysis; Diabetes; Immunization; Medical screening; Primary care; Telemedicine
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2022.33267

ImportanceDespite its rapid adoption during the COVID-19 pandemic, it is unknown how telemedicine augmentation of in-person office visits has affected quality of patient care.ObjectiveTo examine whether quality of care among patients exposed to telemedicine differs from patients with only in-person office-based care.Design, Setting, and ParticipantsIn this retrospective cohort study, standardized quality measures were compared between patients with office-only (in-person) visits vs telemedicine visits from March 1, 2020, to November 30, 2021, across more than 200 outpatient care sites in Pennsylvania and Maryland.ExposuresPatients completing telemedicine (video) visits.Main Outcomes and Measuresχ2tests determined statistically significant differences in Health Care Effectiveness Data and Information Set (HEDIS) quality performance measures between office-only and telemedicine-exposed groups. Multivariable logistic regression controlled for sociodemographic factors and comorbidities.ResultsThe study included 526 874 patients (409 732 office-only; 117 142 telemedicine exposed) with a comparable distribution of sex (196 285 [49.7%] and 74 878 [63.9%] women), predominance of non-Hispanic (348 127 [85.0%] and 105 408 [90.0%]) and White individuals (334 215 [81.6%] and 100 586 [85.9%]), aged 18 to 65 years (239 938 [58.6%] and 91 100 [77.8%]), with low overall health risk scores (373 176 [91.1%] and 100 076 [85.4%]) and commercial (227 259 [55.5%] and 81 552 [69.6%]) or Medicare or Medicaid (176 671 [43.1%] and 52 513 [44.8%]) insurance. For medication-based measures, patients with office-only visits had better performance, but only 3 of 5 measures had significant differences: patients with cardiovascular disease (CVD) receiving antiplatelets (absolute percentage difference [APD], 6.71%; 95% CI, 5.45%-7.98%;P < .001), patients with CVD receiving statins (APD, 1.79%; 95% CI, 0.88%-2.71%;P = .001), and avoiding antibiotics for patients with upper respiratory infections (APD, 2.05%; 95% CI, 1.17%-2.96%;P < .001); there were insignificant differences for patients with heart failure receiving β-blockers and those with diabetes receiving statins. For all 4 testing-based measures, patients with telemedicine exposure had significantly better performance differences: patients with CVD with lipid panels (APD, 7.04%; 95% CI, 5.95%-8.10%;P < .001), patients with diabetes with hemoglobin A1ctesting (APD, 5.14%; 95% CI, 4.25%-6.01%;P < .001), patients with diabetes with nephr