Kakani Preeti, Singer Adam E, Cui Manying, Villaflores Chad W, Vangala Sitaram, Cuevas Miguel A, Han Maria, Damberg Cheryl L, Mafi John N, Sarkisian Catherine A
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at 8783, Los Angeles, CA, USA.
Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
J Telemed Telecare. 2024 Oct 7:1357633X241282820. doi: 10.1177/1357633X241282820.
While telemedicine has been beneficial in oncology by reducing infectious exposure and improving access for patients with poor functional status, it also has intrinsic limitations, including the inability to perform a physical exam, which could lead to increased downstream utilization in this population at high risk of medical decompensation. We conducted a retrospective cohort study investigating the relationship between telemedicine use in oncology and subsequent outpatient oncology encounters, emergency department (ED) visits, and hospitalizations.
We included outpatient oncology encounters, including telemedicine and in-person visits, occurring between 1 January 2018 and 31 December 2022 at a large academic health system. Unadjusted descriptive statistics and multiple linear regressions were used to estimate subsequent outpatient oncology visits, ED visits, and hospitalizations within 30 days of an index visit based on modality (telemedicine versus in-person). The multiple regressions were adjusted for various demographic and clinical characteristics, including palliative care visits, baseline utilization, recent chemotherapy, and comorbidities.
Our cohort included 63,722 patients with 689,356 outpatient encounters, of which 639,217 (92.7%) were in-person and 50,139 (7.3%) were telemedicine visits. Patients on average had 0.91 outpatient oncology visits, 0.04 ED visits, and 0.05 hospitalizations within 30 days following an index encounter. In our adjusted analyses, telemedicine was associated with 13.7 fewer downstream outpatient oncology visits (95% CI 12.5-14.9; < 0.001) per 100 index encounters, 0.7 fewer ED visits (95% CI 0.4-1.0; < 0.001) per 100 index encounters and 0.9 fewer hospitalizations (95% CI 0.6-1.3; < 0.001) per 100 index encounters compared to in-person visits.
Contrary to our hypothesis, oncology patients who had a telemedicine visit had fewer follow-up outpatient oncology encounters, ED visits and hospitalizations after 30 days than those with in-person visits. Future studies should further investigate the efficacy of telemedicine in oncology and outline specific scenarios for appropriate use in this and other populations.
虽然远程医疗在肿瘤学领域具有益处，可减少感染风险并改善身体机能较差患者的就医机会，但它也存在内在局限性，包括无法进行体格检查，这可能导致该高医疗失代偿风险人群后续医疗资源利用增加。我们开展了一项回顾性队列研究，调查肿瘤学中远程医疗使用与后续门诊肿瘤诊疗、急诊就诊及住院之间的关系。
我们纳入了2018年1月1日至2022年12月31日期间在一个大型学术医疗系统发生的门诊肿瘤诊疗，包括远程医疗和面对面就诊。使用未调整的描述性统计和多元线性回归，根据诊疗方式（远程医疗与面对面）估计在索引就诊后30天内的后续门诊肿瘤就诊、急诊就诊和住院情况。多元回归针对各种人口统计学和临床特征进行了调整，包括姑息治疗就诊、基线医疗资源利用、近期化疗和合并症。
我们的队列包括63722名患者，共689356次门诊诊疗，其中639217次（92.7%）为面对面就诊，50139次（7.3%）为远程医疗就诊。患者在索引就诊后的30天内平均有0.91次门诊肿瘤就诊、0.04次急诊就诊和0.05次住院。在我们的调整分析中，与面对面就诊相比，每100次索引就诊中，远程医疗与后续门诊肿瘤就诊减少13.7次相关（95%置信区间12.5 - 14.9；<0.001），急诊就诊减少0.7次（95%置信区间0.4 - 1.0；<0.001），住院减少0.9次（95%置信区间0.6 - 1.3；<0.001）。
与我们的假设相反，进行远程医疗就诊的肿瘤患者在30天后的后续门诊肿瘤诊疗、急诊就诊和住院次数比面对面就诊的患者少。未来的研究应进一步调查远程医疗在肿瘤学中的疗效，并概述在该人群和其他人群中适当使用的具体场景。
