Comparable quality performance between telemedicine and office-based care for abnormal BMI screening and management

Abstract

Background: Despite widespread adoption during COVID-19, there is limited evidence supporting the quality of telemedicine care in managing patients with abnormal BMI. Objective: To evaluate the comparability of telemedicine and in-person (office) quality performance for abnormal body mass index (BMI kg/m2) screening and management in primary care. Methods: This retrospective cohort study measured Healthcare Effectiveness Data and Information Set (HEDIS) quality performance for abnormal BMI screening (patients with BMIs <18.5 or >25 kg/m2 and a qualifying documented follow up plan) across an 8-hospital integrated health system seen via primary care from 4/1/20 - 9/30/21. Encounters were divided into three exposure groups: office (excluding telemedicine), telemedicine (excluding office), and blended telemedicine (office + telemedicine). Demographic stratification compared group composition. Chi squared tests determined statistical differences in quality performance (p = <0.05). Results: Demographics of sub-groups for the 287,387 patients (office: 222,333; telemedicine: 1,556; blended-telemedicine: 63,489) revealed a modest female predominance, majority ages 26–70, mostly White non-Hispanics of low health risk, and the majority BMI representation was overweight, followed closely by class 1 obesity. In both HEDIS specified and HEDIS modified performance, blended-telemedicine performed better than office (12.56%, 95% CI 12.29%–13.01%; 11.16%, 95% CI: 10.85%–11.48%; p < 0.0001); office performed better than telemedicine (4.29%, 95% CI 2.84%–5.54%; 4.79%, 95% CI 3.99%–5.35%; p < 0.0001). Conclusion: Quality performance was highest for blended-telemedicine, followed by office-only, then telemedicine-only. Given the known cost savings, adding telemedicine as a care venue might promote value within health systems without negatively impacting HEDIS performance.