Dataset Information

Telemedicine Utilization in Neurosurgery During the COVID-19 Pandemic: A Glimpse Into the Future?

ABSTRACT:

Objective

To describe telemedicine utilization in neurosurgery at a single tertiary institution to provide outpatient care during the coronavirus disease 2019 (COVID-19) pandemic, with 315 telemedicine visits performed by the neurosurgery department.

Patients and methods

In response to the COVID-19 pandemic national stay-at-home orders and postponed elective surgeries, we converted upcoming clinic visits into telemedicine visits and rescheduled other patients thought not to be markedly affected by surgical postponement. We reviewed the charts of all patients who had telehealth visits from April 1 through April 30, 2020, and collected demographic information, diagnosis, type of visit, and whether they received surgery; a satisfaction questionnaire was also administered.

Results

In March 2020, 94% (644 of 685) of the neurosurgery clinic visits were face-to-face, whereas in April 2020, 55% (315 of 573) of the visits were telemedicine (P<.001). In April, of the 315 telemedicine visits, 172 (55%) were phone consults and 143 (45%) video consults; 101 (32%) were new consults, 195 (62%) return visits, and 18 (6%) postoperative follow-up. New consults were more likely to be video with audio than return visits and postoperative follow-up (P<.001). Only 39 patients (12%) required surgery. Ninety-one percent of the questionnaire respondents were very likely to recommend telemedicine.

Conclusion

Rapid implementation of telemedicine to evaluate neurosurgery patients became an effective tool for preoperative consultation, postoperative and follow-up visits during the COVID-19 pandemic, and decreased risks of exposure to severe acute respiratory syndrome coronavirus 2 to patients and health care staff. Future larger studies should investigate the cost-effectiveness of telemedicine used to triage surgical from nonsurgical patients, potential cost-savings from reducing travel burdens and lost work time, improved access, reduced wait times, and impact on patient satisfaction.

SUBMITTER: De Biase G

PROVIDER: S-EPMC7728424 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

Telemedicine Utilization in Neurosurgery During the COVID-19 Pandemic: A Glimpse Into the Future?

De Biase Gaetano G Freeman William D WD Bydon Mohamad M Smith Nathan N Jerreld Daniel D Pascual Jorge J Casler John J Hasse Chris C Quiñones-Hinojosa Alfredo A Abode-Iyamah Kingsley K

Mayo Clinic proceedings. Innovations, quality & outcomes 20201210 6

<h4>Objective</h4>To describe telemedicine utilization in neurosurgery at a single tertiary institution to provide outpatient care during the coronavirus disease 2019 (COVID-19) pandemic, with 315 telemedicine visits performed by the neurosurgery department.<h4>Patients and methods</h4>In response to the COVID-19 pandemic national stay-at-home orders and postponed elective surgeries, we converted upcoming clinic visits into telemedicine visits and rescheduled other patients thought not to be mar ...[more]

PMID: 33324948

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Project description:ProblemThe COVID-19 pandemic led to changes in both the clinical environment and medical education. The abrupt shift to telemedicine in March 2020, coupled with the recommendation that medical students pause in-person clinical rotations, highlighted the need for student training in telemedicine.ApproachTo maintain students' ability to participate in clinical encounters and continue learning in the new virtual environment, a telemedicine curriculum for clinical students was rapidly developed at Harvard Medical School (HMS) focusing on the knowledge and skills needed to conduct live video encounters. Curriculum leads created an interactive, flexible curriculum to teach students clinical skills, regulatory issues, professionalism, and innovations in telemedicine. This 5-module curriculum was delivered using various primarily asynchronous modalities including webinar-style presentations, prerecorded videos of physical exams from different disciplines, shadowing a synchronous telemedicine visit, peer discussions in small groups, and quizzes with both multiple-choice and open-ended questions.OutcomesDuring May 2020, 252 clerkship and postclerkship medical students at HMS completed the telemedicine curriculum. All students completed a precourse survey and 216 (85.7%) completed the postcourse survey. Students' self-rated knowledge of telemedicine increased, on average, from 38 (15.1%) reporting being fairly/very knowledgeable over 4 domains before the course to 182 (84.3%) afterward (P < .001). The course was highly rated, with 176/205 (85.9%) students reporting that it met their learning needs and 167/205 (81.5%) finding the delivery methods to be effective. Of 101 (45.3%) students who answered an open-ended postcourse survey question, 91 (90.1%) reported asynchronous learning to be a positive experience.Next stepsAs telemedicine becomes increasingly and likely permanently integrated into the health care system, providing medical students with robust training in conducting care virtually will be essential. This curriculum provides a promising and feasible framework upon which other schools can apply these emerging competencies to design their own telemedicine curricula.

Project description:BackgroundThe telemedicine industry has been experiencing fast growth in recent years. The outbreak of coronavirus disease 2019 (COVID-19) further accelerated the deployment and utilization of telemedicine services. An analysis of the socioeconomic characteristics of telemedicine users to understand potential socioeconomic gaps and disparities is critical for improving the adoption of telemedicine services among patients.ObjectivesThis study aims to measure the correlation of socioeconomic determinants with the use of telemedicine services in Milwaukee metropolitan area.MethodsElectronic health record review of patients using telemedicine services compared with those not using telemedicine services within an academic-community health system: patient demographics (e.g., age, gender, race, and ethnicity), insurance status, and socioeconomic determinants obtained through block-level census data in Milwaukee area. The telemedicine users were compared with all other patients using regression analysis. The telemedicine adoption rates were calculated across regional ZIP codes to analyze the geographic patterns of telemedicine adoption.ResultsA total of 104,139 patients used telemedicine services during the study period. Patients who used video visits were younger (median age 48.12), more likely to be White (odds ratio [OR] 1.34; 95% confidence interval [CI], 1.31-1.37), and have private insurance (OR 1.43; CI, 1.41-1.46); patients who used telephone visits were older (median age 57.58), more likely to be Black (OR 1.31; CI 1.28-1.35), and have public insurance (OR 1.30; CI 1.27-1.32). In general, Latino and Asian populations were less likely to use telemedicine; women used more telemedicine services in general than men. In the multiple regression analysis of social determinant factors across 126 ZIP codes, college education (coefficient 1.41, p = 0.01) had a strong correlation to video telemedicine adoption rate.ConclusionAdoption of telemedicine services was significantly impacted by the social determinant factors of health, such as income, education level, race, and insurance type. The study reveals the potential inequities and disparities in telemedicine adoption.

Dataset Information

Telemedicine Utilization in Neurosurgery During the COVID-19 Pandemic: A Glimpse Into the Future?

Objective

Patients and methods

Results

Conclusion

Publications

Telemedicine Utilization in Neurosurgery During the COVID-19 Pandemic: A Glimpse Into the Future?

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