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Trends in the Utilization of Teleneurology and Other Healthcare Resources Prior to and During the COVID-19 Pandemic in an Urban, Tertiary Health System

BACKGROUND: Patient groups traditionally affected by health disparities were less likely to use video teleneurology (TN) care during the initial COVID-19 pandemic surge in the United States. Whether this asymmetry persisted later in the pandemic or was accompanied with a loss of access to care remai...

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Autores principales: Kummer, Benjamin R., Agarwal, Parul, Sweetnam, Chloe, Robinson-Papp, Jessica, Blank, Leah J., Katz Sand, Ilana, Naasan, Georges, Palmese, Christina A., Jimenez-Shahed, Joohi, Grant, Jihan, Patterson, Shanna, Navis, Alison, Stein, Laura K., Jetté, Nathalie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873082/
https://www.ncbi.nlm.nih.gov/pubmed/35222258
http://dx.doi.org/10.3389/fneur.2022.834708
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author Kummer, Benjamin R.
Agarwal, Parul
Sweetnam, Chloe
Robinson-Papp, Jessica
Blank, Leah J.
Katz Sand, Ilana
Naasan, Georges
Palmese, Christina A.
Jimenez-Shahed, Joohi
Grant, Jihan
Patterson, Shanna
Navis, Alison
Stein, Laura K.
Jetté, Nathalie
author_facet Kummer, Benjamin R.
Agarwal, Parul
Sweetnam, Chloe
Robinson-Papp, Jessica
Blank, Leah J.
Katz Sand, Ilana
Naasan, Georges
Palmese, Christina A.
Jimenez-Shahed, Joohi
Grant, Jihan
Patterson, Shanna
Navis, Alison
Stein, Laura K.
Jetté, Nathalie
author_sort Kummer, Benjamin R.
collection PubMed
description BACKGROUND: Patient groups traditionally affected by health disparities were less likely to use video teleneurology (TN) care during the initial COVID-19 pandemic surge in the United States. Whether this asymmetry persisted later in the pandemic or was accompanied with a loss of access to care remains unknown. METHODS: We conducted a retrospective cohort study using patient data from a multicenter healthcare system in New York City. We identified all established pediatric or adult neurology patients with at least two prior outpatient visits between June 16th, 2019 and March 15th, 2020 using our electronic medical record. For this established pre-COVID cohort, we identified telephone, in-person, video TN or emergency department visits and hospital admissions for any cause between March 16th and December 15th, 2020 (“COVID period”). We determined clinical, sociodemographic, income, and visit characteristics. Our primary outcome was video TN utilization, and our main secondary outcome was loss to follow-up during the COVID period. We used multivariable logistic regression to model the relationship between patient-level characteristics and both outcomes. RESULTS: We identified 23,714 unique visits during the COVID period, which corresponded to 14,170 established patients from our institutional Neurology clinics during the pre-COVID period. In our cohort, 4,944 (34.9%) utilized TN and 4,997 (35.3%) were entirely lost to follow-up during the COVID period. In the adjusted regression analysis, Black or African-American race [adjusted odds ratio (aOR) 0.60, 97.5%CI 0.52–0.70], non-English preferred language (aOR 0.49, 97.5%CI 0.39–0.61), Medicaid insurance (aOR 0.50, 97.5%CI 0.44–0.57), and Medicare insurance (aOR 0.73, 97.5%CI 0.65–0.83) had decreased odds of TN utilization. Older age (aOR 0.98, 97.5%CI 0.98–0.99), female sex (aOR 0.90 97.5%CI 0.83–0.99), and Medicaid insurance (aOR 0.78, 0.68–0.90) were associated with decreased odds of loss to follow-up. CONCLUSION: In the first 9 months of the COVID-19 pandemic, we found sociodemographic patterns in TN utilization that were similar to those found very early in the pandemic. However, these sociodemographic characteristics were not associated with loss to follow-up, suggesting that lack of TN utilization may not have coincided with loss of access to care.
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spelling pubmed-88730822022-02-26 Trends in the Utilization of Teleneurology and Other Healthcare Resources Prior to and During the COVID-19 Pandemic in an Urban, Tertiary Health System Kummer, Benjamin R. Agarwal, Parul Sweetnam, Chloe Robinson-Papp, Jessica Blank, Leah J. Katz Sand, Ilana Naasan, Georges Palmese, Christina A. Jimenez-Shahed, Joohi Grant, Jihan Patterson, Shanna Navis, Alison Stein, Laura K. Jetté, Nathalie Front Neurol Neurology BACKGROUND: Patient groups traditionally affected by health disparities were less likely to use video teleneurology (TN) care during the initial COVID-19 pandemic surge in the United States. Whether this asymmetry persisted later in the pandemic or was accompanied with a loss of access to care remains unknown. METHODS: We conducted a retrospective cohort study using patient data from a multicenter healthcare system in New York City. We identified all established pediatric or adult neurology patients with at least two prior outpatient visits between June 16th, 2019 and March 15th, 2020 using our electronic medical record. For this established pre-COVID cohort, we identified telephone, in-person, video TN or emergency department visits and hospital admissions for any cause between March 16th and December 15th, 2020 (“COVID period”). We determined clinical, sociodemographic, income, and visit characteristics. Our primary outcome was video TN utilization, and our main secondary outcome was loss to follow-up during the COVID period. We used multivariable logistic regression to model the relationship between patient-level characteristics and both outcomes. RESULTS: We identified 23,714 unique visits during the COVID period, which corresponded to 14,170 established patients from our institutional Neurology clinics during the pre-COVID period. In our cohort, 4,944 (34.9%) utilized TN and 4,997 (35.3%) were entirely lost to follow-up during the COVID period. In the adjusted regression analysis, Black or African-American race [adjusted odds ratio (aOR) 0.60, 97.5%CI 0.52–0.70], non-English preferred language (aOR 0.49, 97.5%CI 0.39–0.61), Medicaid insurance (aOR 0.50, 97.5%CI 0.44–0.57), and Medicare insurance (aOR 0.73, 97.5%CI 0.65–0.83) had decreased odds of TN utilization. Older age (aOR 0.98, 97.5%CI 0.98–0.99), female sex (aOR 0.90 97.5%CI 0.83–0.99), and Medicaid insurance (aOR 0.78, 0.68–0.90) were associated with decreased odds of loss to follow-up. CONCLUSION: In the first 9 months of the COVID-19 pandemic, we found sociodemographic patterns in TN utilization that were similar to those found very early in the pandemic. However, these sociodemographic characteristics were not associated with loss to follow-up, suggesting that lack of TN utilization may not have coincided with loss of access to care. Frontiers Media S.A. 2022-02-11 /pmc/articles/PMC8873082/ /pubmed/35222258 http://dx.doi.org/10.3389/fneur.2022.834708 Text en Copyright © 2022 Kummer, Agarwal, Sweetnam, Robinson-Papp, Blank, Katz Sand, Naasan, Palmese, Jimenez-Shahed, Grant, Patterson, Navis, Stein and Jetté. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Kummer, Benjamin R.
Agarwal, Parul
Sweetnam, Chloe
Robinson-Papp, Jessica
Blank, Leah J.
Katz Sand, Ilana
Naasan, Georges
Palmese, Christina A.
Jimenez-Shahed, Joohi
Grant, Jihan
Patterson, Shanna
Navis, Alison
Stein, Laura K.
Jetté, Nathalie
Trends in the Utilization of Teleneurology and Other Healthcare Resources Prior to and During the COVID-19 Pandemic in an Urban, Tertiary Health System
title Trends in the Utilization of Teleneurology and Other Healthcare Resources Prior to and During the COVID-19 Pandemic in an Urban, Tertiary Health System
title_full Trends in the Utilization of Teleneurology and Other Healthcare Resources Prior to and During the COVID-19 Pandemic in an Urban, Tertiary Health System
title_fullStr Trends in the Utilization of Teleneurology and Other Healthcare Resources Prior to and During the COVID-19 Pandemic in an Urban, Tertiary Health System
title_full_unstemmed Trends in the Utilization of Teleneurology and Other Healthcare Resources Prior to and During the COVID-19 Pandemic in an Urban, Tertiary Health System
title_short Trends in the Utilization of Teleneurology and Other Healthcare Resources Prior to and During the COVID-19 Pandemic in an Urban, Tertiary Health System
title_sort trends in the utilization of teleneurology and other healthcare resources prior to and during the covid-19 pandemic in an urban, tertiary health system
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873082/
https://www.ncbi.nlm.nih.gov/pubmed/35222258
http://dx.doi.org/10.3389/fneur.2022.834708
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