Association of primary care telehealth with preventable healthcare utilization and care continuity among patients with chronic conditions.

Abstract

Telehealth may help maintain access to care for individuals with chronic conditions, particularly during periods of disruption. This study examined the association between telehealth use and health care utilization, continuity, and quality in primary care. We used a difference-in-differences design (2019-2021) to compare outcomes for patients attributed to practices with high versus low telehealth uptake before and after the onset of the COVID-19 pandemic across three clinical research networks. Outcomes included evaluation and management visits, preventable emergency department visits, avoidable hospitalizations, Bice-Boxerman and Usual Provider of Care continuity indices, and disease-specific quality measures. Among 383,570 Medicare fee-for-service patient-quarters with chronic conditions, telehealth use was not associated with changes in preventable emergency department visits or hospitalizations. Continuity of care, measured by the Bice-Boxerman Index, increased by 0.01 (95% CI, 0.002 to 0.017), corresponding to an 8.3% greater increase relative to the pre-period mean in high versus low telehealth practices. However, telehealth use was associated with declines in selected disease-specific quality measures, including beta-blocker use among patients with heart failure (-0.04; 95% CI, -0.08 to -0.002) and controlled blood pressure among patients with hypertension (-0.10; 95% CI, -0.14 to -0.06). These findings suggest that telehealth may support continuity of care without increasing acute care utilization, although its implications for chronic disease management quality remain uncertain.