Table 5. Association of Telehealth With Likelihood of Any, Emergency, or Hospitalization Follow-ups for Patients With Specific Acute and Chronic Ambulatory Care Sensitive Conditionsa.
| Clinical condition | Patients, No. (%) | Adjusted OR (95% CI) | ||
|---|---|---|---|---|
| Any follow-up encounter | ED follow-up | Hospitalization follow-up | ||
| Acute ambulatory care sensitive conditions | ||||
| Acute bronchitis | ||||
| First encounter: telehealth | 9245 (23.3) | 1.23 (1.17-1.30) | 1.18 (1.05-1.33) | 1.04 (0.91-1.18) |
| First encounter: in person | 30 381 (76.7) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Acute pharyngitis | ||||
| First encounter: telehealth | 36 399 (16.1) | 1.46 (1.42-1.49) | 1.10 (1.01-1.19) | 0.98 (0.89-1.08) |
| First encounter: in person | 189 567 (83.9) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Acute pyelonephritis | ||||
| First encounter: telehealth | 389 (19.0) | 0.94 (0.71-1.26) | 100 (0.65-1.53) | 0.93 (0.56-1.54) |
| First encounter: in person | 1655 (81.0) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Acute tonsillitis | ||||
| First encounter: telehealth | 3758 (13.8) | 1.03 (0.96-1.11) | 0.80 (0.64-0.99) | 0.86 (0.62-1.21) |
| First encounter: in person | 23 424 (86.2) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Acute upper respiratory tract infections of multiple and unspecified sites | ||||
| First encounter: telehealth | 49 336 (21.5) | 1.65 (1.61-1.68) | 1.18 (1.10-1.25) | 1.11 (1.03-1.20) |
| First encounter: in person | 180 034 (78.5) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Convulsions, not elsewhere classified | ||||
| First encounter: telehealth | 1022 (24.8) | 0.69 (0.59-0.81) | 0.79 (0.53-1.18) | 1.10 (0.77-1.57) |
| First encounter: in person | 3099 (75.2) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Diseases of pulp and periapical tissues | ||||
| First encounter: telehealth | 2480 (19.0) | 1.01 (0.92-1.10) | 0.98 (0.77-1.24) | 0.92 (0.67-1.27) |
| First encounter: in person | 10 570 (81.0) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Other diseases of lip and oral mucosa | ||||
| First encounter: telehealth | 2271 (13.5) | 0.96 (0.87-1.06) | 1.01 (0.75-1.36) | 1.01 (0.71-1.44) |
| First encounter: in person | 14 573 (86.5) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Pneumonia, unspecified organism | ||||
| First encounter: telehealth | 1402 (15.9) | 1.68 (1.37-2.06) | 1.07 (0.84-1.38) | 0.76 (0.59-0.99) |
| First encounter: in person | 7420 (84.1) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Stomatitis and related lesions | ||||
| First encounter: telehealth | 2187 (15.1) | 1.06 (0.96-1.17) | 1.29 (1.00-1.65) | 0.96 (0.69-1.35) |
| First encounter: in person | 12 284 (84.9) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Chronic ambulatory care sensitive conditions | ||||
| Asthma | ||||
| First encounter: telehealth | 23 878 (24.7) | 0.98 (0.95-1.01) | 0.98 (0.88-1.08) | 0.92 (0.82-1.03) |
| First encounter: in person | 72 918 (75.3) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Epilepsy and recurrent seizures | ||||
| First encounter: telehealth | 3013 (28.3) | 0.83 (0.76-0.91) | 0.92 (0.69-1.22) | 0.91 (0.68-1.20) |
| First encounter: in person | 7645 (71.7) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Essential (primary) hypertension | ||||
| First encounter: telehealth | 42 450 (16.5) | 0.86 (0.84-0.88) | 0.96 (0.88-1.05) | 0.96 (0.89-1.03) |
| First encounter: in person | 215 227 (83.5) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Heart failure | ||||
| First encounter: telehealth | 556 (12.5) | 0.63 (0.50-0.80) | 0.86 (0.54-1.36) | 1.05 (0.77-1.43) |
| First encounter: in person | 3908 (87.5) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Hypertensive heart disease | ||||
| First encounter: telehealth | 1259 (14.3) | 0.76 (0.66-0.88) | 0.89 (0.62-1.27) | 1.11 (0.85-1.46) |
| First encounter: in person | 7551 (85.7) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Iron deficiency anemia | ||||
| First encounter: telehealth | 2812 (23.5) | 1.24 (1.10-1.40) | 0.99 (0.79-1.25) | 0.89 (0.73-1.09) |
| First encounter: in person | 9174 (76.5) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Other and unspecified noninfective gastroenteritis and colitis | ||||
| First encounter: telehealth | 7586 (25.7) | 1.28 (1.20-1.36) | 1.09 (0.96-1.24) | 0.93 (0.79-1.09) |
| First encounter: in person | 21 929 (74.3) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Other chronic obstructive pulmonary disease | ||||
| First encounter: telehealth | 1961 (17.6) | 0.93 (0.83-1.04) | 1.06 (0.82-1.37) | 0.96 (0.76-1.20) |
| First encounter: in person | 9165 (82.4) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Other disorders of teeth and supporting structures | ||||
| First encounter: telehealth | 1479 (19.7) | 1.01 (0.90-1.13) | 0.83 (0.61-1.13) | 1.15 (0.80-1.65) |
| First encounter: in person | 6044 (80.3) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Type 1 diabetes mellitus | ||||
| First encounter: telehealth | 689 (13.6) | 0.73 (0.61-0.87) | 1.12 (0.72-1.75) | 0.74 (0.46-1.18) |
| First encounter: in person | 4365 (86.4) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Type 2 diabetes mellitus | ||||
| First encounter: telehealth | 8798 (14.3) | 1.11 (1.05-1.17) | 0.74 (0.61-0.90) | 0.90 (0.78-1.03) |
| First encounter: in person | 52 817 (85.7) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
Abbreviations: ED, emergency department; OR, odds ratio.
a
The logistic regression models (2 separate models for acute and chronic ambulatory care sensitive conditions) included an interaction term between the type of initial encounter and the specific ambulatory care sensitive condition to address how telehealth effectiveness may vary by each clinical condition type. The models were adjusted for age, sex, Elixhauser Comorbidity Index, urban or rural status of residence, COVID-19 hotspot of residence, Area Deprivation Index, internet connectivity, severity index (for chronic conditions only), and the type of acute and chronic ambulatory care sensitive conditions. Refer to eTables 5 and 10 in the Supplement for more information on the approach to selecting acute and chronic ambulatory care sensitive conditions for the assessment of use patterns and the summary of acute and chronic ambulatory care sensitive conditions and subsequent utilization patterns during 2020.