Comparison of Quality Performance Measures for Patients Receiving In-Person vs Telemedicine Primary Care in a Large Integrated Health System

Abstract

Importance: Despite its rapid adoption during the COVID-19 pandemic, it is unknown how telemedicine augmentation of in-person office visits has affected quality of patient care. Objective: To examine whether quality of care among patients exposed to telemedicine differs from patients with only in-person office-based care. Design, Setting, and Participants: In this retrospective cohort study, standardized quality measures were compared between patients with office-only (in-person) visits vs telemedicine visits from March 1, 2020, to November 30, 2021, across more than 200 outpatient care sites in Pennsylvania and Maryland. Exposures: Patients completing telemedicine (video) visits. Main Outcomes and Measures: χ2 tests determined statistically significant differences in Health Care Effectiveness Data and Information Set (HEDIS) quality performance measures between office-only and telemedicine-exposed groups. Multivariable logistic regression controlled for sociodemographic factors and comorbidities. Results: The study included 526874 patients (409732 office-only; 117142 telemedicine exposed) with a comparable distribution of sex (196285 [49.7%] and 74878 [63.9%] women), predominance of non-Hispanic (348127 [85.0%] and 105408 [90.0%]) and White individuals (334215 [81.6%] and 100586 [85.9%]), aged 18 to 65 years (239938 [58.6%] and 91100 [77.8%]), with low overall health risk scores (373176 [91.1%] and 100076 [85.4%]) and commercial (227259 [55.5%] and 81552 [69.6%]) or Medicare or Medicaid (176671 [43.1%] and 52513 [44.8%]) insurance. For medication-based measures, patients with office-only visits had better performance, but only 3 of 5 measures had significant differences: patients with cardiovascular disease (CVD) receiving antiplatelets (absolute percentage difference [APD], 6.71%; 95% CI, 5.45%-7.98%; P