The Effectiveness of Neurologic Telehealth Outpatient Care During the COVID-19 Pandemic
Chloe Hill1, Chun Chieh Lin2, Ellen Anderson-Benge3, Christine Esper4, Kavita Nair5, Adam De Havenon6, Neil Busis7, Gregory Esper4, Brian Callaghan1
1University of Michigan, 2The Ohio State University, 3American Academy of Neurology, 4Emory University, 5University of Colorado, 6Yale University, 7NYU Langone Health
Objective:
To assess the adequacy of telehealth evaluation as compared to in-person evaluation in neurologic clinic visits.
Background:
The Covid-19 pandemic offers an opportunity to evaluate telehealth visits to inform future care delivery.
Design/Methods:
The full study will be a multi-institutional retrospective analysis of neurologic care at six academic health centers; this abstract reports data from one institution, the University of Michigan. We compared neurologic patients with a telehealth new patient visit (cases) to patients with an in-person new patient visit (controls) from September 2020-December 2021. The primary interest was adequacy of telehealth evaluation, thus the primary outcome was a follow-up neurologic clinic visit within 90 days (likely faster than standard follow-up). Emergency room (ER) visits and hospitalizations for neurologic diagnoses following the initial clinic visit were also assessed. Outcomes were measured across several neurologic diagnosis categories (e.g., epilepsy, stroke, headache). Propensity score matching by diagnosis, demographics, and prior healthcare utilization was conducted to reduce bias in care modality selection.
Results:
We identified 4,336 telehealth and 4,690 in-person neurologic patients with new patient visits resulting in 3,074 cases and 3,074 controls following propensity score matching. There was no significant difference in follow-up neurologic clinic visits within 90 days between telehealth and in-person new patient visits (18% vs. 16.2%, p=0.06). ER visits occurred less frequently in the telehealth cohort (0.6% vs. 1.1%, p=0.03); no increase in hospitalizations was seen in the telehealth cohort (2.3% vs. 2.5%, p=0.74). Future exploration with the multi-institutional cohort will examine differences in care patterns by neurologic diagnosis.
Conclusions:
There were no differences in follow-up clinic visits between telehealth and in-person neurologic new patient visits. While residual confounding likely exists, these results suggest that large differences in subsequent healthcare utilization are unlikely. There may be important differences by neurologic diagnosis, which will be evaluated in subsequent work.