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Surgery

Use of Telehealth by Surgical Specialties During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Surgery

Published Online: March 26, 2021

Original Investigation

Article Information and Disclosures

Grace F. Chao, MD, MSc^1,2,3,4;

Kathleen Y. Li, MD, MSc^4,5,6;

Ziwei Zhu, MS⁴;

Jeff McCullough, PhD⁷;

Mike Thompson, PhD⁸;

Jake Claflin, MD⁹;

Maximilian Fliegner, BA⁴;

Emma Steppe, MPH⁴;

Andrew Ryan, PhD⁴;

Chad Ellimoottil, MD, MSc^4,9

Author Affiliations

¹National Clinician Scholars Program, University of Michigan, Ann Arbor
²Veterans Affairs Ann Arbor, Ann Arbor, Michigan
³Department of Surgery, Yale School of Medicine, New Haven, Connecticut
⁴Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
⁵Department of Emergency Medicine, University of Michigan, Ann Arbor
⁶Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
⁷Department of Health Management and Policy, University of Michigan, Ann Arbor
⁸Department of Cardiac Surgery, Michigan Medicine, Ann Arbor
⁹Department of Urology, University of Michigan, Ann Arbor

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Key Points

Question What were telehealth use patterns across surgical specialties before and during the COVID-19 pandemic?

Findings In this statewide cohort study that included 4405 surgeons, telehealth use grew substantially during the early pandemic period and declined during the later period; this use varied by surgical specialty. Compared with 2019 visit volume, telehealth salvaged only a small portion of 2020 surgical visits.

Meaning Telehealth is being used in surgical fields at rates higher than before the pandemic, and its use varies across surgical specialties.

Abstract

Importance While telehealth use in surgery has shown to be feasible, telehealth became a major modality of health care delivery during the COVID-19 pandemic.

Objective To assess patterns of telehealth use across surgical specialties before and during the COVID-19 pandemic.

Design, Setting, and Participants Insurance claims from a Michigan statewide commercial payer for new patient visits with a surgeon from 1 of 9 surgical specialties during one of the following periods: prior to the COVID-19 pandemic (period 1: January 5 to March 7, 2020), early pandemic (period 2: March 8 to June 6, 2020), and late pandemic (period 3: June 7 to September 5, 2020).

Exposures Telehealth implementation owing to the COVID-19 pandemic in March 2020.

Main Outcomes and Measures (1) Conversion rate defined as the rate of weekly new patient telehealth visits divided by mean weekly number of total new patient visits in 2019. This outcome adjusts for a substantial decrease in outpatient care during the pandemic. (2) Weekly number of new patient telehealth visits divided by weekly number of total new patient visits.

Results Among 4405 surgeons in the cohort, 2588 (58.8%) performed telehealth in any patient care context. Specifically for new patient visits, 1182 surgeons (26.8%) used telehealth. A total of 109 610 surgical new outpatient visits were identified during the pandemic. The median (interquartile range) age of telehealth patients was 46.8 (34.1-58.4) years compared with 52.6 (38.3-62.3) years for patients who received care in-person. Prior to March 2020, less than 1% (8 of 173 939) of new patient visits were conducted through telehealth. Telehealth use peaked in April 2020 (week 14) and facilitated 34.6% (479 of 1383) of all new patient visits during that week. The telehealth conversion rate peaked in April 2020 (week 15) and was equal to 8.2% of the 2019 mean weekly new patient visit volume. During period 2, a mean (SD) of 16.6% (12.0%) of all new patient surgical visits were conducted via telehealth (conversion rate of 5.1% of 2019 mean weekly new patient visit volumes). During period 3, 3.0% (2168 of 71 819) of all new patient surgical visits were conducted via telehealth (conversion rate of 2.5% of 2019 new patient visit volumes). Mean (SD) telehealth conversion rates varied by specialty with urology being the highest (14.3% [7.7%]).

Conclusions and Relevance Results from this study showed that telehealth use grew across all surgical specialties in Michigan in response to the COVID-19 pandemic. While rates of telehealth use have declined as in-person care has resumed, telehealth use remains substantially higher across all surgical specialties than it was prior to the pandemic.

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Article Information

Corresponding Author: Grace F. Chao, MD, MSc, National Clinician Scholars Program, Veterans Affairs Ann Arbor, 2800 Plymouth Rd, Bldg 14, Ste G100, Ann Arbor, MI 48109 (grace.f.chao@yale.edu).

Accepted for Publication: January 16, 2021.

Published Online: March 26, 2021. doi:10.1001/jamasurg.2021.0979

Author Contributions: Dr Chao had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Chao, Li, McCullough, Thompson, Fliegner, Steppe, Ryan, Ellimoottil.

Acquisition, analysis, or interpretation of data: Chao, Li, Zhu, McCullough, Thompson, Claflin, Ellimoottil.

Drafting of the manuscript: Chao, Claflin, Fliegner, Ellimoottil.

Critical revision of the manuscript for important intellectual content: Chao, Li, Zhu, McCullough, Thompson, Fliegner, Steppe, Ryan, Ellimoottil.

Statistical analysis: Chao, Li, Zhu, McCullough, Thompson, Ryan, Ellimoottil.

Obtained funding: Ellimoottil.

Administrative, technical, or material support: Claflin, Steppe, Ellimoottil.

Supervision: Thompson, Ellimoottil.

Conflict of Interest Disclosures: Dr Chao reports funding from the Veterans Affairs Center for Clinical Management Research at the VA Ann Arbor Healthcare System. Dr Li receives funding from the National Institutes of Health National Heart, Lung, and Blood Institute. Dr Thompson reports receiving partial salary support from Blue Cross Blue Shield of Michigan outside the submitted work. Dr Ellimoottil receives funding from the Agency for Healthcare Research and Quality. No other disclosures were reported.

Funding/Support: This work was supported by the Telehealth Research Incubator project grant (MPrOVE Research Challenge Grant).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: This work does not represent the views of the US government nor the US Department of Veterans Affairs.

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.