Naqvi Imama A, Cohen Audrey S, Kim Youngran, Harris Jennifer, Denny Mary Carter, Strobino Kevin, Bicher Nathan, Leite Ryan A, Sadowsky Dylan, Adegboye Comfort, Okpala Nnedinma, Okpala Munachi, Savitz Sean I, Marshall Randolph S, Sharrief Anjail
Department of Neurology (IAN, KS, RSM), Division of Stroke and Cerebrovascular Diseases, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY; Department of Neurology (ASC, YK, NO, MO, SIS, AS) and Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, TX; Department of Neurology (JH), Division of Stroke and Cerebrovascular Disease, Cedar-Sinai Medical Center, Los Angeles, CA; Department of Neurology (MCD, NB, RAL, DS), Georgetown University Medical Center and MedStar Georgetown University Hospital, Washington, DC; Howard University (CA), Washington, DC.
Neurol Clin Pract. 2023 Apr;13(2):e200148. doi: 10.1212/CPJ.0000000000200148. Epub 2023 Mar 14.
In response to the COVID-19 pandemic, outpatient stroke care delivery was rapidly transformed to outpatient evaluation through video (VTM) and telephone (TPH) telemedicine (TM) visits around the world. We sought to evaluate the sociodemographic differences in outpatient TM use among stroke patients.
We conducted a retrospective chart review of outpatients evaluated at 3 tertiary stroke centers in the early period of the pandemic, 3/16/2020 through 7/31/2020. We compared the use of TM by patient characteristics including age, sex, race/ethnicity, insurance status, stroke type, patient type, and site. The association between TM use and patient characteristics was measured using the relative risk (RR) from a modified Poisson regression, and site-specific effects were controlled using a multilevel analysis.
A total of 2,024 visits were included from UTHealth (n = 878), MedStar Health (n = 269), and Columbia (n = 877). The median age was 64 [IQR 52-74] years, and 53% were female. Approximately half of the patients had private insurance, 36% had Medicare, and 15% had Medicaid. Two-thirds of the visits were established patients. TM accounted for 90% of total visits, and the use of TM over office visits was primarily associated with site, not patient characteristics. TM utilization was associated with Asian and other/unknown race. Among TM users, older age, Black race, Hispanic ethnicity, and Medicaid insurance were associated with lower VTM use. Black (aRR 0.88, 95% CI 0.86-0.91, < 0.001) and Hispanic patients (aRR 0.92, 95% CI 0.87-0.98, = 0.005) had approximately 10% lower VTM use, while Asian patients (aRR 0.98, 95% CI 0.89-1.07, = 0.59) had similar VTM use compared with White patients. Patients with Medicaid were less likely to use VTM compared with those with private insurance (aRR 0.86, 95% CI 0.81-0.91, < 0.001).
In our diverse cohort across 3 centers, we found differences in TM visit type by race and insurance early during the COVID-19 pandemic. These findings suggest disparities in VTM access across different stroke populations. As VTM remains an integral part of outpatient neurology practice, steps to ensure equitable access are essential.
为应对新冠疫情，全球范围内门诊卒中护理迅速转变为通过视频（VTM）和电话（TPH）远程医疗（TM）进行门诊评估。我们旨在评估卒中患者门诊使用远程医疗的社会人口学差异。
我们对2020年3月16日至2020年7月31日疫情早期在3个三级卒中中心接受评估的门诊患者进行了回顾性病历审查。我们比较了患者特征（包括年龄、性别、种族/族裔、保险状况、卒中类型、患者类型和就诊地点）对远程医疗使用情况的影响。使用修正泊松回归的相对风险（RR）来衡量远程医疗使用与患者特征之间的关联，并通过多水平分析控制特定地点的影响。
共纳入了来自德克萨斯大学健康科学中心（UTHealth，n = 878）、MedStar Health（n = 269）和哥伦比亚大学（n = 877）的2024次就诊。中位年龄为64岁[四分位间距52 - 74岁]，53%为女性。约一半患者拥有私人保险，36%拥有医疗保险，15%拥有医疗补助。三分之二的就诊患者为复诊患者。远程医疗占总就诊次数的90%，远程医疗相对于门诊就诊的使用主要与就诊地点有关，而非患者特征。远程医疗的使用与亚裔及其他/不明种族有关。在远程医疗使用者中，年龄较大、黑人种族、西班牙裔族裔和医疗补助保险与视频远程医疗使用较低有关。黑人患者（调整后相对风险[aRR]0.88，95%置信区间[CI]0.86 - 0.91，P < 0.001）和西班牙裔患者（aRR 0.92，95% CI 0.87 - 0.98，P = 0.005）的视频远程医疗使用约低10%，而亚裔患者（aRR 0.98，95% CI 0.89 - 1.07，P = 0.59）与白人患者的视频远程医疗使用相似。与拥有私人保险的患者相比，拥有医疗补助的患者使用视频远程医疗的可能性较小（aRR 0.86，95% CI 0.81 - 0.91，P < 0.001）。
在我们涵盖3个中心的多样化队列中，我们发现在新冠疫情早期，不同种族和保险类型的患者在远程医疗就诊类型上存在差异。这些发现表明不同卒中人群在视频远程医疗获取方面存在差异。由于视频远程医疗仍然是门诊神经科实践的一个重要组成部分，确保公平获取的措施至关重要。
