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Central Surgical Association

49th Annual Meeting

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Impact of the adoption of telehealth for outpatient visits from a thoracic service during the COVID-19 pandemic.
Isabel Emmerick1, Kevin Dickson2, Olivia Sears2, Chelsea Lim2, Keren Guiab1, Bryce Bludevich2, Maggie Powers1, Feiran Lou1, Mark Maxfield1, Karl Uy1
1Division of Thoracic Surgery, UMass Chan Medical School, Worcester, Massachusetts, United States, 2UMass Chan Medical School, Worcester, Massachusetts, United States

Objective The COVID-19 pandemic has presented various challenges for the healthcare system, among them is the struggle to safely provide care for cancer patients. This study aims to estimate the impact of the adoption of telehealth for outpatient visits as tool to reduce disease exposure for patients and providers and to minimize the impact on care for patients with cancer during the COVID-19 pandemic.
Methods: This is a longitudinal quasi-experimental time series analysis evaluating the effect of the telehealth Outpatient Visits (OPV) on minimizing the impact of COVID-19. Data derived from the institutional electronic medical records from January 2018 to December 2021 was analyzed considering the implementation of telehealth services in the first and second waves of COVID-19 cases in Massachusetts; March, and November, 2020, respectively. The main outcomes were average of (A) Monthly Overall-OPV-; (B) Monthly in-person-OPV; (C) Monthly Overall-cancer-OPV; (D) Monthly in-person-cancer-OPV.
Results: A total of 5,918 outpatient visits were analyzed. 55.3% of the visits were for female patients, 87% for White patients, and the overall average patient age was 66 years. Telehealth accounted for 25.8% of the total of visits, and 27.7% of cancer-related. Female patients were more likely to have a telehealth visit. White, Black, and Asian patients presented with a similar telehealth use (26.3%, 25.0% and 26.8%), while Latinos were less likely to have a telehealth visit (18%, p-value<0.02). Age was not significantly different between telehealth and non-telehealth visits, however for those who preferred a phone appointment, the average age was 67 years old while those who used video visits the age was 63 (p-value <0.05). For the outcomes (A) and (C) which include the telehealth visits, the COVID-19 surges did not have a statistically significant impact the average OPV. On the other hand, there was a statistically significant decline for in-person OPV overall (B) and cancer (D) following the policies implemented to reduce the spread of COVID-19. Over time, the thoracic surgery service was able to successfully provide care for its patients. The use of telehealth prevented a decline in appointments of 59% (p-value= 0.001) overall and 40% (p-value=0.0190) for cancer.
Conclusions: The use of telehealth allowed patients to safely receive care throughout the COVID-19 Pandemic and had a positive impact on the maintenance of care for patients with cancer in a single thoracic surgery service. The adoption of telehealth can be used to expand access to care in the pandemic context and in low-resource areas. Nevertheless, future studies should evaluate possible disparities regarding availability, equipment for accessing telehealth, and telehealth usage for cancer patients during the COVID-19 pandemic, especially for the underserved population.

Interrupted time series analysis for (A) Monthly Overall-OPV-; (B) Monthly in-person-OPV; (C) Monthly Overall-cancer-OPV; (D) Monthly in-person-cancer-OPV. Thoracic Service, Worcester, MA. January 2018 to December 2021


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