From bedside to broadband: Evaluating outcomes of telehealth infectious diseases consultations.

Abstract

Telemedicine is increasingly used to expand access to infectious diseases (ID) specialists but data on patient outcomes are limited. We compared patient outcomes of inpatient in-person ID consultations and tele-ID in a community hospital. One of two community hospitals in our health system transitioned from in-person to telehealth ID consultation (tele-ID). We examined a retrospective cohort of patients receiving ID consultations in both hospitals before and after the transition while accounting for secular trends. A total of 3,223 patients received ID consultation in the telemedicine switch hospital (1,682 during the in-person period and 1,541 during the tele-ID period). Length of stay among patients receiving ID consultation did not differ between the pre-telehealth and telehealth periods (median 7 (IQR 4-13) vs. 7 (IQR 5-13) days, p=0.47). Similarly, 30-day readmission (17.4% vs. 17.7%, p=0.86), 30-day mortality (9.2% vs. 8.7%, p=0.65), and combined 30-day death/readmission (25.9% vs. 25.6%, p=0.88) did not differ between the pre-telehealth and telehealth periods. Multivariable modeling adjusting for age, sex, race, modified Charlson score, and hospital demonstrated no significant associations between receiving tele-ID care and 30-day readmission, death, or days dead/hospitalized within 90 days after the initial ID consultation. The mean number of computed tomography/magnetic resonance imaging studies during the index admission was significantly higher at the telehealth switch hospital during the telehealth period (2.28) than the pre-telehealth period (1.69, p<0.001 for comparison). Transition to tele-ID was not associated with any increase in patient-relevant adverse outcomes but was associated with increased imaging utilization.