The association of oncology telehealth visits with acute care events and follow-up appointments.
Authors: Elston Lafata Jennifer , Fridman Ilona , Kinlaw Alan C. , Jordan Lauren C.J. , Tam Samantha , Smith Angela B. , Wood William Allen , Stein Jacob Newton , Dunn Matthew , Neslund-Dudas Christine 
Published: September 2024

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Background:
Use of telehealth visits in cancer care expanded with the pandemic, yet few studies have assessed its impact on subsequent care outcomes. We evaluated differences in acute care events (ACEs) and follow-up visits among patients with telehealth compared to in-person oncology visits.
Methods:
We identified a cohort of adults with an upcoming oncology visit related to their cancer treatment at two academic medical centers (in central NC and southeast MI) and their community affiliates. Black adults and those with a scheduled telehealth visit were oversampled. Pre-visit surveys administered by telephone collected information on sociodemographic characteristics, prior telehealth use, health status/symptoms and travel distance. We joined survey and electronic health record (EHR) data and used geocoding to assign census-tract-level community characteristics to participants. ACE and follow-up visit use were ascertained via the EHR. Unadjusted and adjusted prevalence differences in ACEs within 30 and 180 days as well as follow-up visits within 7 and 30 days were assessed by visit type.
Results:
502 patients were study eligible, 90 telehealth and 412 in-person visits. In unadjusted and adjusted models, the proportion of patients incurring an ACE within 7 and 30 days was not significantly different (6 vs. 3% and 17 vs. 10%, telehealth vs. in-person, respectively). Nor did the proportion of patients having a follow-up visit within 7 or 30 days differ significantly (26 vs. 20% and 65 vs. 54%, telehealth vs. in-person, respectively). Some patient characteristics were similar regardless of visit format. For example, most patients were older (63 mean age SD 13), not currently employed (66%), and reported getting by/living comfortably with current income (88%), having some college education (80%), no transportation troubles (85%), and activated patient portal accounts (89%). Symptom presentation per the PRO-CTCAE was similar between groups as was broadband connectivity. Telehealth patients were significantly less likely to be Black (14 vs. 44%), female (48 vs. 72%), have breast cancer (22 vs. 48%), received chemotherapy (72 vs. 83%), or to live within 60 minutes of care (49 vs. 68%), and more likely to have advanced disease (24 vs. 14%), report LGBTQ sexual orientation (10 vs. 4%), and be married (70 vs. 57%).
Conclusions:
Similar ACE and follow-up visit use among those with telehealth and in-person visits supports the idea that telehealth could be a viable substitute for some in-person care within oncology. Differences between those using telehealth and in-person visits highlight equity concerns and missed opportunities to enhance patient convenience and other aspects of care access. To better understand telehealth’s impact, not only on care use, but other indicators of quality (including patient outcomes), matching via propensity score analyses are needed and underway.