SAT137 Variation In Use Of Telehealth For Endocrinology Care - Patterns Under The "New Normal”
Authors: Vimalananda Varsha , Qian Shirley , Arao Kevin A , Leibowitz Alison , Zupa Margaret , Benzer Justin , Zocchi Mark , Fincke Graeme , Meterko Mark , Berlowitz Dan , Sitter Kailyn , Wormwood Jolie 
Published: October 2023

Abstract
Disclosure: V. Vimalananda: None. S. Qian: None. K.A. Arao: None. A. Leibowitz: None. M. Zupa: None. J. Benzer: None. M. Zocchi: None. G. Fincke: None. M. Meterko: None. D. Berlowitz: None. K. Sitter: None. J. Wormwood: None.
Background: Use of telehealth (telephone or video) for outpatient care peaked early in the COVID-19 pandemic. Use has decreased since that time but remains well above pre-pandemic levels. We described the observed levels of variation in telehealth use under this “new normal” and examined the predictors of its utilization for endocrinology outpatient care. These data can be used to develop strategies to ensure equitable access for endocrine patients to clinically appropriate modes of care. Methods: Cross-sectional study of national data from the Veterans Health Administration (VA), the largest integrated health system in the U.S. Multivariable mixed effects logistic regression models were used to identify patient-, clinician-, facility-, and Veterans Integrated Service Network (VISN)-level characteristics associated with telehealth use among patients seen for outpatient endocrinology from 3/9/21 – 3/8/22. We examined two outcomes: telehealth (telephone or video) v. in-person visits, and within the subsample of telehealth visits, telephone v. video visits. Results: The dataset included 167,017 patients, 618 clinicians, 99 facilities, and 18 VISNs for visits that were in person (58%), telephone (29%), and video (13%). Intraclass correlation coefficients revealed unique variability in telehealth use accounted for by each level of the analysis (56% patient/visit, 24% clinician, 18% facility, and 2% VISN). Visits were more likely to be telehealth (v. in person) if the visit was a follow-up (v. an initial consultation: OR 1.99, 95%CI [1.93, 2.06]); the clinician was an APN (v. physician: OR 2.11, 95%CI [1.06, 2.76]); the clinician was full-time (OR 1.46, 95%CI [1.15, 1.87]); and the facility was of higher complexity (OR 3.40, 95%CI [1.51, 7.68]). Among telehealth visits, unique variability in telephone (vs. video) usage was accounted for by each level of the analysis (44% patient/visit, 24% clinician, 26% facility, and 6% VISN). Telehealth visits were significantly more likely to be telephone (v. video) for follow-up visits (vs. initial consultation: OR 2.22, 95%CI [2.09, 2.35], for moderately disabled patients with partial copays (v. patients with poverty, no copayments: OR 1.36, 95%CI [1.28,1.47]), for diabetes visits (vs. bone/mineral disorder: OR 1.30, 95%CI [1.20, 1.41], and for facilities serving a more rural population (OR 16.6, 95%CI [2.2, 123.4]). Conclusion: This study found wide variation in use of telehealth for endocrinology under the “new normal”. A significant amount of this variation may reflect uneven use among clinicians or differences in facility use of telehealth. More work is needed to investigate the range of reasons for variation at the clinician and facility level, particularly as many of those drivers may be amenable to influence by clinical leaders and could be leveraged to enhance availability of all clinically appropriate modes of care for endocrine patients.
Presentation: Saturday, June 17, 2023