Assessment of Clinician Diagnostic Concordance With Video Telemedicine in the Integrated Multispecialty Practice at Mayo Clinic During the Beginning of COVID-19 Pandemic From March to June 2020.

Autor:	Demaerschalk BM; Department of Neurology and Center for Digital Health, Mayo Clinic College of Medicine and Science, Phoenix, Arizona., Pines A; Mayo Clinic Alix School of Medicine, Phoenix, Arizona.; Now with Department of Psychiatry, Brigham & Women's Hospital, Boston, Massachusetts., Butterfield R; Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Phoenix, Arizona., Haglin JM; Mayo Clinic Alix School of Medicine, Phoenix, Arizona.; Department of Orthopedic Surgery, Mayo Clinic College of Medicine and Science, Phoenix, Arizona., Haddad TC; Department of Medical Oncology and Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota., Yiannias J; Department of Dermatology and Center for Digital Health, Mayo Clinic College of Medicine and Science, Phoenix, Arizona., Colby CE; Department of Pediatric and Adolescent Medicine, Neonatology, Critical Care, and Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota., TerKonda SP; Department of Surgery and Plastic and Reconstructive Surgery, Center for Digital Health, Mayo Clinic College of Medicine and Science, Jacksonville, Florida., Ommen SR; Department of Cardiovascular Medicine and Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota., Bushman MS; Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota., Lokken TG; Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota., Blegen RN; Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota., Hoff MD; Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota., Coffey JD; Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota., Anthony GS; Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota., Zhang N; Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Phoenix, Arizona.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2022 Sep 01; Vol. 5 (9), pp. e2229958. Date of Electronic Publication: 2022 Sep 01.
DOI:	10.1001/jamanetworkopen.2022.29958
Abstrakt:	Importance: There was a shift in patient volume from in-person to video telemedicine visits during the COVID-19 pandemic. Objective: To determine the concordance of provisional diagnoses established at a video telemedicine visit with diagnoses established at an in-person visit for patients presenting with a new clinical problem. Design, Setting, and Participants: This is a diagnostic study of patients who underwent a video telemedicine consultation followed by an in-person outpatient visit for the same clinical problem in the same specialty within a 90-day window. The provisional diagnosis made during the video telemedicine visit was compared with the reference standard diagnosis by 2 blinded, independent medical reviewers. A multivariate logistic regression model was used to determine factors significantly related to diagnostic concordance. The study was conducted at a large academic integrated multispecialty health care institution (Mayo Clinic locations in Rochester, Minnesota; Scottsdale and Phoenix, Arizona; and Jacksonville, Florida; and Mayo Clinic Health System locations in Iowa, Wisconsin, and Minnesota) between March 24 and June 24, 2020. Participants included Mayo Clinic patients residing in the US without age restriction. Data analysis was performed from December 2020 to June 2021. Exposures: New clinical problem assessed via video telemedicine visit to home using Zoom Care Anyplace integrated into Epic. Main Outcomes and Measures: Concordance of provisional diagnoses established over video telemedicine visits compared against a reference standard diagnosis. Results: There were 2393 participants in the analysis. The median (IQR) age of patients was 53 (37-64) years; 1381 (57.7%) identified as female, and 1012 (42.3%) identified as male. Overall, the provisional diagnosis established over video telemedicine visit was concordant with the in-person reference standard diagnosis in 2080 of 2393 cases (86.9%; 95% CI, 85.6%-88.3%). Diagnostic concordance by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision chapter ranged from 64.7% (95% CI, 42.0%-87.4%) for diseases of the ear and mastoid process to 96.8% (95% CI, 94.7%-98.8%) for neoplasms. Diagnostic concordance by medical specialty ranged from 77.3% (95% CI, 64.9%-89.7%) for otorhinolaryngology to 96.0% (92.1%-99.8%) for psychiatry. Specialty care was found to be significantly more likely than primary care to result in video telemedicine diagnoses concordant with a subsequent in-person visit (odds ratio, 1.69; 95% CI, 1.24-2.30; P < .001). Conclusions and Relevance: This diagnostic study of video telemedicine visits yielded a high degree of diagnostic concordance compared with in-person visits for most new clinical concerns. Some specific clinical circumstances over video telemedicine were associated with a lower diagnostic concordance, and these patients may benefit from timely in-person follow-up.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu