How concordant to an in-person diagnosis are provisional diagnoses established at a video telemedicine visit for patients presenting with a new clinical problem?
In this diagnostic study of 2393 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 established over video telemedicine visit matched the in-person reference standard diagnosis in 86.9% of cases.
These findings suggest that video telemedicine visits yield a high degree of diagnostic concordance to in-person visits for most new clinical concerns.
There was a shift in patient volume from in-person to video telemedicine visits during the COVID-19 pandemic.
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.
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.
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.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: July 15, 2022.
Published: September 2, 2022. doi:10.1001/jamanetworkopen.2022.29958
Correction: This article was corrected on October 17, 2022, to fix a misspelled name in Supplement 2.
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Demaerschalk BM et al. JAMA Network Open.
Corresponding Author: Bart M. Demaerschalk, MD, MSc, Department of Neurology and Center for Digital Health, Mayo Clinic College of Medicine and Science, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054 (firstname.lastname@example.org).
Author Contributions: Dr Demaerschalk and Mr Butterfield had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Demaerschalk, Pines, Butterfield, TerKonda, Bushman, Lokken, Blegen, Hoff, Coffey, Anthony, Zhang.
Acquisition, analysis, or interpretation of data: Demaerschalk, Pines, Butterfield, Haglin, Haddad, Yiannias, Colby, TerKonda, Ommen, Bushman, Coffey, Zhang.
Drafting of the manuscript: Demaerschalk, Pines, Butterfield, Haglin, TerKonda, Lokken, Coffey, Anthony.
Critical revision of the manuscript for important intellectual content: Demaerschalk, Pines, Butterfield, Haddad, Yiannias, Colby, TerKonda, Ommen, Bushman, Blegen, Hoff, Coffey, Zhang.
Statistical analysis: Demaerschalk, Butterfield, Haglin, Zhang.
Obtained funding: Demaerschalk, Bushman.
Administrative, technical, or material support: Demaerschalk, TerKonda, Bushman, Lokken, Blegen, Coffey, Anthony.
Supervision: Demaerschalk, Haddad, Ommen.
Conflict of Interest Disclosures: None reported.
Funding/Support: This study was supported by the Mayo Clinic Department of Research (grant 90256993).
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.
Group Information: The Diagnostic Accuracy of Telemedicine Utilized at Mayo Clinic Alix School of Medicine Study Group Investigators are listed in Supplement 2.
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