Associations of Telemedicine vs. In-Person Ambulatory Care Visits on Cancellation Rates and 30-Day Follow-Up Hospitalizations and Emergency Department Visits

Importance Studies have shown that telemedicine use in specific conditions can promote continuity of care, decreases healthcare costs, and can potentially improve clinical outcomes. The COVID-19 pandemic forced many healthcare systems to expand access for patients using telemedicine, but little is known about cancellation frequencies in telemedicine vs. in-person appointments and its impact on clinical outcomes. Objective Compare ambulatory clinic cancellation rates, 30-day inpatient hospitalizations rates, and 30-day emergency department visit rates between in-person and video telemedicine appointments, and examine differences in cancellation rates by age, race/ethnicity, gender, and insurance. Design A retrospective cohort study. Setting The largest academic healthcare system in the state of Georgia with ambulatory clinics in urban, suburban and rural settings. Participants Adults scheduled for an ambulatory clinic appointment from June 2020 to December 2020 were included. Each appointment was identified as either a video telemedicine or in-person clinic appointment. Demographics including age, race, ethnicity, gender, primary insurance, and comorbidities were extracted from the electronic medical record. Main Outcomes and Measures The primary process outcome was ambulatory clinic cancellation rates. The primary clinical outcomes were 30-day hospitalization rates and 30-day emergency department visit rates. Multivariable logistic regression was used to assess differences in the clinical outcomes between appointment types. Results A total of 1,652,623 ambulatory clinic appointments were scheduled during the study period. Ambulatory appointment cancellations rates were significantly lower among telemedicine appointments compared to in-person appointments (20.5% vs. 31.0%, p <.001). Cancellation rates were significantly lower for telemedicine appointments than in-person appointments regardless of gender, age, race, ethnicity, primary insurance, or specialty (p <.05 for all sub-groups). Telemedicine appointments was associated with lower 30-day hospitalization rates compared to in-person appointments (2.1% vs. 2.8%; aOR: 0.72, 95% CI: 0.71 to 0.74). There was no difference in 30-day emergency department visit rates between telemedicine and in-person appointment patients (2.6% vs. 2.6%: aOR: 1.00, 95% CI: 0.98 to 1.02) Conclusions and Relevance Our findings suggest that there are fewer barriers to attending an ambulatory care visit via telemedicine relative than in-person. Moreover, using telemedicine was not associated with any more frequent adverse clinical events compared with in-person visits.