Changes in provider responsibilities and associated outcomes for cirrhotic patients with telehealth: A single-center, retrospective study.

Abstract

BackgroundStudies show satisfaction with telemedicine, but there is limited data regarding changes in provider practices and clinical outcomes. We sought to evaluate the impact of telehealth on patient-provider communications between visits and clinical outcomes in patients with cirrhosis during the COVID-19 pandemic.MethodsSingle-center retrospective study of cirrhotic patients seen outpatient in 2019 and 2020 was conducted. Clinical characteristics, provider practices, and clinical outcomes were obtained. Provider practices included medication adjustments, labs ordered, and patient communication. Clinical outcomes included ED visits, hospitalizations, and mortality.ResultsTotally, 1395 patients were included with a mean age of 61, 51% female, and 73% Caucasian. The median baseline model for end-stage liver disease (MELD-Na) score was 10. During 2019 there were no telehealth visits. In 2020, 37% of clinic visits were telehealth and 64% of patients had at least one telehealth visit. The rate of medication changes significantly decreased in 2020. There was no significant difference in number of clinic visits, labs ordered, emergency department visits, hospitalizations, or intensive care unit (ICU) stays between 2019 and 2020. In 2020, the rate of telephone contacts and patient messages significantly increased. Compared to 2019, the odds of death were 2.6 times higher in 2020.ConclusionWhen a majority of cirrhotic patients had a telehealth visit, patients had similar rates of emergency department visits, hospitalizations, and ICU stays, but a higher rate of mortality compared to patients with in-person visits. Telehealth was associated with more patient contact between visits, increasing communication demands on providers.