Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 7, 2022
Open Peer Review Period: Nov 7, 2022 - Nov 14, 2022
Date Accepted: Jan 11, 2023
Date Submitted to PubMed: Jan 12, 2023
(closed for review but you can still tweet)
Virtual Care During the COVID-19 Pandemic: Difference in Differences Analysis of Program Financial and Clinical Impact
ABSTRACT
Background:
Virtual care (VC) and remote patient monitoring programs were deployed widely during the COVID-19 pandemic. Deployments were heterogenous and evolved as the pandemic progressed, complicating subsequent attempts to quantify their impact. The unique arrangement of the Military Health System (MHS) enabled direct comparison between facilities that did, and did not, implement a VC program.
Objective:
Describe the operational model of a VC program for COVID-19, evaluate its financial impact and detail its clinical outcomes.
Methods:
Retrospective difference-in-differences (DiD) evaluation that compared eight Military Treatment Facilities (MTFs) with, and 39 MTFs without, the VC program. Tricare Prime beneficiaries diagnosed with COVID-19 (MS-DRG 177, U07.1/07.2), eligible for care within the MHS, aged 21 and over, between December 2020-2021 were included. Primary outcomes were length of stay and associated cost savings; secondary outcomes were escalation to physical care from home, 30-day readmissions, adherence to wearable and alarms per patient-day.
Results:
1,838 patients with COVID-19 were admitted to an MTF with the VC program, of 3,988 admitted in the MHS in total. The DiD analysis indicated that centers with the program had a 12% lower length of stay averaged across all COVID-19 patients (saving approximately $2,000 per patient). Two hundred-and-thirty-seven of the 1,838 patients (13%) were enrolled in the VC program. Median wearable adherence was 85 (IQR 63-94)%. Two-hundred-and-three (85.7%) were monitored at home and then directly discharged from VC. Twenty-seven (11.4%) were escalated to a physical hospital bed, and there were no increases in 30-day readmissions or Emergency Department visits.
Conclusions:
Despite only enrolling 13% of COVID-19 patients at centers where it was available, the program offered substantial savings averaged across all patients in those centers without adversely affecting clinical outcomes. An appropriate technological solution and dedicated nurse monitoring staff were intrinsic to the program’s success, and speed of adoption may have been helped by the structure of the MHS.
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