Office of Ambulatory Care and Population Health, New York City Health+Hospitals, New York, New York, USA.
Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York, USA.
J Eval Clin Pract. 2023 Sep;29(6):887-892. doi: 10.1111/jep.13905. Epub 2023 Jul 29.
Video visits became more widely available during the coronavirus disease (COVID-19) pandemic. However, the ongoing role and value of video visits in care delivery and how these may have changed over time are not well understood.
Compare the relative complexity of in-person versus video visits during the COVID-19 pandemic and describe the complexity of video visits over time.
We used billing data for in-person and video revisits from non-behavioural health specialities with the most video visit utilisation (≥50th percentile) at a large, urban, public healthcare system from 1 January 2021 to 31 March 2022. We used current procedural terminology (CPT) codes as a proxy for information gathering and decision-making complexity and time spent on an encounter. We compared the distribution of CPT codes 99211-99215 between in-person and video visits using Fisher's exact tests. We used Spearman correlation to test for trends between proportions of CPT codes over time for video visits.
Ten specialities (adult primary care, paediatrics, adult dermatology, bariatric surgery, paediatric endocrinology, obstetrics and gynaecologist, adult haematology/oncology, paediatric allergy/immunology, paediatric gastroenterology, and paediatric pulmonology) met inclusion criteria. For each speciality, proportions of each CPT code for in-person visits and for video visits varied significantly, and patterns of variation differed by speciality. For example, in adult primary care, video visits had smaller proportions of moderate/high complexity visits (99214 and 99215) and greater proportions of lower complexity visits (99211-99213) compared with in-person visits (p < 0.001), but in paediatric endocrinology, the opposite was seen (p < 0.001). Trends in CPT codes over time for video visits in each speciality were also mixed.
In-person and video visits had differing proportions of complexity codes (typically skewing towards lower complexity for video visits). The complexity of video visits changed over time in many specialities. Observed patterns for both phenomena varied by speciality.
在冠状病毒病（COVID-19）大流行期间，视频就诊变得更加普及。然而，视频就诊在护理提供中的持续作用和价值，以及这些作用和价值随时间的变化尚不清楚。
比较 COVID-19 大流行期间面对面就诊和视频就诊的相对复杂性，并描述视频就诊的复杂性随时间的变化。
我们使用了一家大型城市公立医疗系统中，视频就诊利用率最高（≥50%）的非行为健康专科的面对面和视频复诊的计费数据。我们使用当前程序术语（CPT）代码作为信息收集和决策复杂性以及就诊时间的代理。我们使用 Fisher 精确检验比较了 CPT 代码 99211-99215 在面对面和视频就诊中的分布。我们使用 Spearman 相关检验测试了视频就诊中 CPT 代码比例随时间的趋势。
有 10 个专科（成人初级保健、儿科、成人皮肤科、减肥手术、儿科内分泌学、妇产科、成人血液学/肿瘤学、儿科过敏/免疫学、儿科胃肠病学和儿科肺病学）符合纳入标准。对于每个专科，面对面就诊和视频就诊的每个 CPT 代码的比例差异显著，且变化模式因专科而异。例如，在成人初级保健中，与面对面就诊相比，视频就诊中中等/高复杂性就诊（99214 和 99215）的比例较小，而低复杂性就诊（99211-99213）的比例较大（p<0.001），但在儿科内分泌学中则相反（p<0.001）。每个专科的视频就诊中 CPT 代码随时间的趋势也存在差异。
面对面就诊和视频就诊的复杂性代码比例不同（通常视频就诊的复杂性较低）。在许多专科中，视频就诊的复杂性随时间而变化。这两种现象的观察模式因专科而异。
