Patient Satisfaction with the Hybrid Telemedicine Model for Ophthalmology

Background: The purpose of this research was to compare patient satisfaction between hybrid ophthalmology telemedicine and standard-of-care in-person visits. A retrospective, cross-sectional, case-control analysis of patient satisfaction based on survey data was used. Methods: Responses to the National Research Council Health Patient Survey were retrieved for randomly sampled hybrid ophthalmology telemedicine and in-person visits between March 11, 2020 and December 31, 2021 at a hospital-based eye clinic in Boston, Massachusetts. The primary outcome was based on the question "How likely would you be to recommend this provider to your family and friends?" (0-10 scale) with a score of 9 or 10 coded as satisfied. Two-sample t-tests, Pearson's chi-square tests, and bivariate logistic regressions were used to compare patient satisfaction scores between the hybrid and in-person cohorts. Demographic data, including age, sex, language, and self-reported race and ethnicity, were used as potential predictors of patient satisfaction in a multivariable logistic regression model. Results: There were 49 surveys from hybrid visits and 3,390 surveys from in-person visits. Hybrid visit patients reported high satisfaction scores without significant differences compared to in-person visit patients (hybrid 79% satisfied, in-person 82% satisfied, p = 0.728). Age was significantly associated with satisfaction in the hybrid cohort with the 65+ age group reporting lower satisfaction (below 65 years 100% satisfied, 65+ years 60% satisfied, p = 0.003). No association with age was observed in the in-person cohort. Conclusions: The hybrid ophthalmology telemedicine model can provide effective care without sacrificing patient satisfaction. Older patients may benefit from targeted interventions in future telemedicine models.

Demographic and socioeconomic disparities in the hybrid ophthalmology telemedicine model

IMPORTANCE

As telemedicine use expands, it is important to evaluate demographic and socioeconomic disparities among patients receiving ophthalmic care through new hybrid telemedicine models.

OBJECTIVE

To evaluate whether there are demographic and socioeconomic disparities in the delivery of the hybrid telemedicine model.

DESIGN

Retrospective, cross-sectional, case-control analysis of patient encounters from April to December 2020.

SETTING

A single, academic, hospital-based eye clinic in Boston, Massachusetts.

METHODS

Electronic medical records of all patient encounters from April to December 2020 were reviewed and categorized into hybrid, virtual-only, and standard in-person visits. Patient-level data for all visits were extracted including age, sex, race/ethnicity, primary language, Area Deprivation Index (ADI), insurance type, and marital status. Visit-level data for all hybrid visits were also extracted from the medical record including the visit dates and patient adherence. Demographics for the cohort of patients with at least one no-show visit were compared with demographics for the cohort of patients who only had completed visits. The primary study outcomes were the differences in demographic characteristics between the hybrid visit show and no-show groups. The secondary outcomes included demographic characteristics of patients who did not complete their hybrid visit versus a time-matched cohort of patients who did not complete their standard in-person visit. Continuous variables for patient characteristics were compared with independent samples t-tests and categorical variables were compared using Pearson chi-square tests. Multivariate logistic regression was used to examine the differences between the cohorts. Variables with missing values other than suppressed ADI values were imputed using multiple imputations by chained equations.

RESULTS

Of a total of 1025 patients who were scheduled for a hybrid visit, 145 (14.1%) patients failed to complete their visit. Primary language and insurance were found to be statistically different between patients who completed and did not complete their hybrid visits. More English speakers and fewer Haitian Creole speakers completed their hybrid visits (p = 0.007) while more patients with private insurance and fewer patients with Medicaid completed their hybrid telemedicine visits (p = 0.026). No associations were found between hybrid telemedicine visit adherence and age, sex, race/ethnicity, marital status, or ADI. When the 145 patients who failed to complete their hybrid visits were compared to a time-matched cohort of patients who failed to complete their standard in-person visit, we found that patients who missed hybrid visits were similar to those who missed standard in-person visits except for patients insured by Medicare. These patients were more likely to miss a hybrid visit than a standard in-person visit (Odds Ratio 2.199, 95% confidence interval 1.136-4.259, p = 0.019). No associations were found between patient nonadherence with hybrid telemedicine versus with standard in-person visits based on age, sex, primary language, race/ethnicity, marital status, or ADI.

CONCLUSION

The hybrid telemedicine model was associated with insurance and language-based disparities. Patients with non-English primary language and Medicaid recipients were more likely to miss a hybrid visit than their counterparts. Our findings support developing deliberate interventions to ensure hybrid telemedicine care is delivered equitably to all patients.

Outcomes of a Hybrid Ophthalmology Telemedicine Model for Outpatient Eye Care During COVID-19

IMPORTANCE

The hybrid ophthalmology telemedicine model asynchronously pairs an imaging appointment by a technician with a subsequent virtual appointment by a clinician. Although it has been mentioned in several studies as an alternative to standard in-person care during the COVID-19 pandemic, outcomes of this alternative clinical care model remain to be evaluated.

OBJECTIVE

To investigate the outcomes associated with the hybrid ophthalmology telemedicine model during the COVID-19 pandemic for nonurgent and nonprocedural ophthalmological care.

DESIGN, SETTING, AND PARTICIPANTS

Retrospective, cross-sectional study of all hybrid visits scheduled during the year 2020 in a single academic, hospital-based eye clinic in Boston, Massachusetts. All hybrid ophthalmology telemedicine visits completed in the year 2020 by opthalmologists and optometrists were included. Data were analyzed from January to December 2020.

EXPOSURES

Hybrid telemedicine clinical encounters.

MAIN OUTCOMES AND MEASURES

Four outcome metrics were calculated: (1) need for subsequent procedure visit, (2) medication change, (3) nonurgent, and (4) urgent consultation with another eye clinician. Adverse outcomes were defined as irreversible vision loss and the need for additional in-person evaluation to reach a management decision.

RESULTS

From April 9 to December 30, 2020, 889 patients (506 female patients [56.9%]; mean [SD] age, 62.1 [14.5] years; age range, 13-98 years) completed 940 hybrid visits. The most common visit indications were glaucoma (424 visits [45.1%]) and retinal diseases (499 visits [53.1%]). A total of 25 visits (2.7%) led to a procedure, 22 visits (2.3%) led to a change in medication, and 44 visits (4.7%) were referred for nonurgent consultation with another subspecialty with no instances of urgent referrals. Sixteen patients (1.7%) were referred to the on-call clinician for a same-day emergency in-person visit or recommended for a subsequent standard in-person visit to reach a management decision. There were no cases of irreversible vision loss following a hybrid visit.

CONCLUSIONS AND RELEVANCE

These findings suggest that with the appropriate patient selection and clinical setting, the hybrid ophthalmology telemedicine model may be a good alternative to standard in-person visits, particularly for patients with glaucoma and retinal diseases.

Anterior elbow release of spastic elbow flexion deformity in children with cerebral palsy

This study evaluated anterior elbow release for spastic elbow flexion deformity in children with cerebral palsy. Forty-two consecutive surgical procedures are reported in 40 children with a minimum of 1 year of follow-up. The procedure included incision of the lacertus fibrosus, fractional lengthening of the brachialis aponeurosis, and denuding the peritendinous adventitia from the biceps tendon to remove afferent nerve fibers and receptors. Preoperative and postoperative measurements of the flexion posture angle, active extension, and active flexion were obtained, as well as completion of a written questionnaire by the parents. Flexion posture angle improved from 104 degrees before surgery to 55 degrees after surgery, a reduction of 49 degrees; active extension improved from 43 degrees to 27 degrees. There was no significant change in elbow flexion. Before surgery, the average percentage use of the arm was 12%, which improved significantly to 44% after surgery. The authors conclude that anterior elbow release can significantly improve the flexion posture angle and active extension of the elbow, as well as both the functional use and aesthetic appearance of the involved upper limb.