Comparing Outcomes of Musculoskeletal Radiographs from In-Person and Telemedicine Primary Care Cohorts, April 2019–June 2021

Abstract

Purpose: Musculoskeletal conditions are a common reason for primary care visits, and they are being increasingly addressed at televisits. We therefore examined outcomes of musculoskeletal radiographs ordered at in-person and telemedicine primary care visits, which have implications for patient care and the economic impact of telemedicine. Methods: We performed a retrospective cohort study of musculoskeletal radiograph orders placed April 1, 2019–March 31, 2021 at a major academic health system. Radiology reports were classified as normal or abnormal based on the radiologist’s impression. Findings were compared using c2 tests. Results: The main outcome was radiographic abnormalities. A secondary outcome was the effect of social determinants of health and medical comorbidities on telemedicine utilization. A total of 1580 radiographs were reviewed. Compared with televisits occurring after onset of the SARS-Cov2-19 pandemic, radiographs ordered at in-person visits had higher odds of being abnormal (OR 2.51, 95% CI 1.33–4.75; P ¼.004). When comparing radiographic outcomes at in-person visits before and after the pandemic’s onset, those ordered afterward had higher odds of being abnormal (OR 1.88, 95% CI 1.30–2.71; P