Assessment of Clinician Diagnostic Concordance With Video Telemedicine in the Integrated Multispecialty Practice at Mayo Clinic During the Beginning of COVID-19 Pandemic From March to June 2020
Authors: Demaerschalk Bart M. , Pines Andrew , Butterfield Richard , Haglin Jack M. , Haddad Tufia C. , Yiannias James , Colby Christopher E. , TerKonda Sarvam P. , Ommen Steve R. , Bushman Matthew S. , Lokken Troy G. , Blegen Rebecca N. , Hoff Mekenzie D. , Coffey Jordan D. , Anthony Greg S. , Zhang Nan ,   Diagnostic Accuracy of Telemedicine Utilized at Mayo Clinic Alix School of Medicine Study Group Investigators, Anaya Stephanie , Arbon Jake , Berry Nicholas , Bhargav Adip , Breslin Lauren , Cummings Gabrielle , Ekstein Sam , Fung Cecilia , Gorman Benjamin , Harrington Maya , Hwang James , Jarvis Tyler , Kirollos Monica , Lang Meg , Lopdrup Rachel , Malekian Sheila , Patel Parth Pradip , Pollock Jordan , Roth Alex , Saifuddin Hiba , Shimshak Serena , Sykora Daniel , VanLith Caitlin , Wilder Samantha , Wu Samuel 
Published: September 2022

Importance

There was a shift in patient volume from in-person to video telemedicine visits during the COVID-19 pandemic.

Objective

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.

Exposures

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.

Results

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 &amp;lt; .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.