Accepted for/Published in: JMIR Cancer
Date Submitted: Aug 31, 2022
Date Accepted: Dec 19, 2022
Date Submitted to PubMed: Jan 4, 2023
Telehealth use following COVID-19 within patient-sharing physician networks in a rural comprehensive cancer center: cross-sectional analysis
ABSTRACT
Background:
In response to the COVID-19 pandemic, cancer centers rapidly adopted telehealth to deliver care remotely. Telehealth will likely remain a model of care for years to come and may not only affect the way oncologists deliver care to their own patients, but also the physicians with whom they share patients.
Objective:
The objective of this study was to examine oncologist characteristics associated with telehealth use and compare patient-sharing networks before and after the COVID-19 pandemic in a rural comprehensive cancer center.
Methods:
In this retrospective observational study, we obtained de-identified electronic health record data for individuals diagnosed with breast, colorectal, or lung cancer at Dartmouth Health in New Hampshire in 2018-2020. Hierarchical logistic regression was used to identify physician factors associated with telehealth encounters post-COVID. Patient-sharing networks for each cancer type pre- and post-COVID were characterized with global network measures and exponential random graph models.
Results:
Of the 12,559 encounters between patients and oncologists post-COVID, 1,228 (9.8%) were via telehealth. Patient encounters with breast oncologists who practiced at the hub hospital were over twice as likely to occur via telehealth compared to encounters with oncologists who practiced in regional facilities (odds ratio [OR] (95% confidence interval [CI]) = 2.2 (1.17-4.15)). Patient encounters with oncologists who practiced in multiple locations were less likely to occur via telehealth, and this association was statistically significant for lung cancer care (OR (95% CI) = 0.26 (0.09-0.76)). We observed an increase in ties between oncologists at the hub hospital and oncologists at regional facilities in the lung cancer network post-COVID compared to pre-COVID, but there was no significant difference observed in breast cancer or colorectal cancer networks.
Conclusions:
Telehealth use and associated changes to patient-sharing patterns associated with telehealth varied by cancer type, suggesting disparate approaches for integrating telehealth across clinical groups within this health system.
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.