Search

Background: Despite its rapid expansion, little is known about use of direct to consumer (DTC) telemedicine., Objective: To characterize telemedicine patients and physicians and correlates of patient satisfaction DESIGN: Cross-sectional study PARTICIPANTS: Patients and physicians of a large nationwide DTC telemedicine service MAIN MEASURES: Patient characteristics included demographics and whether or not they reported insurance information. Physician characteristics included specialty, board certification, and domestic versus international medical training. Encounter characteristics included time of day, wait time, length, coupon use for free or reduced-cost care, diagnostic outcome, prescription receipt, and patient/physician geographic concordance. Patients rated satisfaction with physicians on scales of 0 to 5 stars and reported where they would have sought care had they not used telemedicine. Logistic regression was used to assess factors associated with 5-star physician ratings., Key Results: The analysis included 28,222 encounters between 24,040 patients and 277 physicians completed between January 2013 and August 2016. Sixty-five percent of patients were under 40 years and 32% did not report insurance information. Family medicine was the most common physician specialty (47%) and 16% trained at a non-US medical school. Coupons were used in 24% of encounters. Respiratory infections were diagnosed in 35% of encounters and 69% resulted in a prescription. Had they not used telemedicine, 43% of patients reported they would have used urgent care/retail clinic, 29% would have gone to the doctor's office, 15% would have done nothing, and 6% would have gone to the emergency department. Eighty-five percent of patients rated their physician 5 stars. High satisfaction was positively correlated with prescription receipt (OR 2.98; 95%CI 2.74-3.23) and coupon use (OR 1.47; 95%CI 1.33-1.62)., Conclusions: Patients were largely satisfied with DTC telemedicine, yet satisfaction varied by coupon use and prescription receipt. The impact of telemedicine on primary care and emergency department use is likely to be small under present usage patterns.

Background: How case volume and quality of care relate to hospital costs or length of stay (LOS) are important questions as we seek to improve the value of health care., Methods: We conducted an observational study of patients 18 years or older who underwent coronary artery bypass grafting surgery in a network of US hospitals. Case volumes were estimated using our data set. Quality was assessed by whether recommended medications and services were not received in ideal patients, as well as the overall number of measures missed. We used multivariable hierarchical models to estimate the effects of case volume and quality on hospital cost and LOS., Results: The majority of hospitals (51%) and physicians (78%) were lowest-volume providers, and only 18% of patients received all quality of care measures. Median LOS was 7 days (interquartile range [IQR], 6-11 days), and median costs were $25 140 (IQR, $19 677-$33 121). In analyses adjusted for patient and site characteristics, lowest-volume hospitals had 19.8% higher costs (95% CI, 3.9%-38.0% higher); adjusting for care quality did not eliminate differences in costs. Low surgeon volume was also associated with higher costs, though less strongly (3.1% higher costs [95% CI, 0.6%-5.6% higher]). Individual quality measures had inconsistent associations with costs or LOS, but patients who had no quality measures missed had much shorter LOS and lower costs than those who missed even one., Conclusion: Avoiding lowest-volume hospitals and maximizing quality are separate approaches to improving health care efficiency through reducing costs of coronary bypass surgery.