Comparing Outcomes: In-Person and Telehealth Oncology Visits.

Abstract

Telemedicine offers significant benefits, but concerns regarding care quality persist. To inform future oncology telehealth policy, we compared subsequent health care use, patient-reported care quality, and communication outcomes between telehealth and in-person visits. An observational cohort study (April 2022-October 2023) included patients age 21+ years with malignant neoplasms, a scheduled oncology visit, and cancer treatment initiated 6 months to 3 years before the study. Black adults and those with telehealth visits were oversampled. Pre- and post-visit telephone survey data were joined with electronic health record data and geocoded community characteristics. Outcomes included subsequent acute care events (emergency department visits and unplanned hospitalizations), follow-up visits, patient perceptions of whether their care needs were met, and communication quality via validated instruments, with Likert-scale responses. We estimated prevalence differences (PDs) in outcomes by visit type using propensity score-weighted generalized linear models that adjusted for patient socioeconomic, health, and census tract-level differences. After propensity score adjustments achieved covariate balance, 487 respondents (93 telehealth, 394 in-person) were included. Mean age was 64 (standard deviation = 13) years; 62% were female, 26% were Black, 82% had some college degree or more, and 25% reported fair/poor health. Follow-up in-person visits at 30 days were more frequent after telehealth (64%, 46%; PD = 0.18 [95% CI, 0.07 to 0.28]), with no differences at 7 or 14 days. Acute care use did not significantly differ at any time point. Quality and communication ratings were similar (PD range: 0.00-0.09), except for perceived privacy: 80% in-person, 67% telehealth, <i>P</i> < .01. Although mostly similar health care use and patient perceptions suggest telehealth as a viable oncology option, identified differences highlight the need to ensure privacy and evaluate when telehealth visits are most appropriate.