Investigating the Association Between Telemedicine Use and Timely Follow-Up Care After Acute Cardiovascular Hospital Encounters

Figures

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  Figure 1. Unadjusted 14-Day Follow-up Rates During the Prepandemic, Transition, and Pandemic Steady-State Time Periods Follow-up is defined as a completed outpatient visit with a cardiovascular, cardiac surgery, or general internal medicine physician or advanced practice provider within 14 days of discharge. Follow-up modality denotes the most intensive visit type used within the 14 days following discharge (most intensive is in-person, while audio-only is least intensive). ACS = acute coronary syndrome; AD = arrhythmia disorders; HF = heart failure; VHD = valvular heart disease.

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  Figure 2. Adjusted Difference in 14-Day Follow-up Rates, 2020 vs 2019 Point estimates represent differences in 14-day follow-up rate in 2020 vs 2019 in each of our 3 time periods. Estimates are adjusted for encounter and patient characteristics. Error bars reflect 95% confidence intervals with heteroskedasticity robust standard errors. ACS = acute coronary syndrome; AD = arrhythmia disorders; HF = heart failure; VHD = valvular heart disease.

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  Figure 3. Time to First Follow-up Cumulative Distribution Curves Stratified by Condition and Year Only includes encounters from the pandemic steady state that had at least 1 follow-up visit within 60 days of discharge. Time to first follow-up is the number of days from discharge to the patients’ first follow-up. Follow-up defined as a completed outpatient visit with cardiovascular, cardiac surgery, or general internal medicine physician or advanced practice provider following discharge. ACS = acute coronary syndrome; AD = arrhythmia disorders; HF = heart failure; VHD = valvular heart disease.

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  Figure 4. Adjusted Difference in 30-Day All-Cause Unplanned Readmission Rate, 2020 vs 2019 Thirty-day unplanned readmissions include any emergency department, observation, or inpatient stays within 30 days of the index encounter discharge date. Readmissions are not restricted to those with cardiology primary diagnosis codes. Point estimates represent differences in readmission rates in each of our 3 time periods in 2020 vs 2019. Estimates are adjusted for encounter and patient characteristics. Error bars reflect 95% confidence intervals with heteroskedasticity robust standard errors. ACS = acute coronary syndrome; AD = arrhythmia disorders; HF = heart failure; VHD = valvular heart disease.

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  Central Illustration. Increased Telemedicine Use Was Associated With Improvements in Early Follow-Up Rate and No Worse Readmission Rate Acute cardiovascular hospital encounters include encounters for acute coronary syndrome, arrhythmia disorders, heart failure, and valvular heart disease resulting in hospitalizations, emergency department (ED) visits, or observation stays. The graph in the top left shows 2020 weekly telemedicine visit volume as a percentage of total outpatient visit volume for cardiovascular or cardiac surgery physicians and advanced practice providers (APPs) (top) and general internal medicine physicians and APPs (bottom). The red highlighted weeks correspond to the pandemic “transition” period (March 1, 2020-May 23, 2020), while the green highlighted weeks correspond to the pandemic “steady state” period (May 24, 2020-December 31, 2020). Telemedicine visits include both video and audio-only visits. Fourteen-day follow-up is defined as a completed outpatient visit with a cardiovascular, cardiac surgery, or general internal medicine physician or APP within 14 days of discharge. Thirty-day unplanned readmissions include any ED, observation, or inpatient stays within 30 days of the…