Impact of Initial Cardiology Telemedicine Evaluation on Follow-Up Visits for Common Conditions: Quasi-Experimental Study
Abstract BackgroundTelemedicine use has increased significantly in cardiology clinics, but the impact of initial telemedicine evaluation on total visit usage is unknown. ObjectiveThis study aimed to determine the effect of initial telemedicine evaluation on the num...
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JMIR Publications
2025-08-01
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| Series: | Journal of Medical Internet Research |
| Online Access: | https://www.jmir.org/2025/1/e73509 |
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| author | Neil M Kalwani Harrison Koos Emily Kohn Vijaya Parameswaran Anica Oesterle Marina Adrianzen Febri Kurniawan Lubna Qureshi Rajesh Dash Paul Heidenreich David Scheinker Fatima Rodriguez |
| author_facet | Neil M Kalwani Harrison Koos Emily Kohn Vijaya Parameswaran Anica Oesterle Marina Adrianzen Febri Kurniawan Lubna Qureshi Rajesh Dash Paul Heidenreich David Scheinker Fatima Rodriguez |
| author_sort | Neil M Kalwani |
| collection | DOAJ |
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Abstract
BackgroundTelemedicine use has increased significantly in cardiology clinics, but the impact of initial telemedicine evaluation on total visit usage is unknown.
ObjectiveThis study aimed to determine the effect of initial telemedicine evaluation on the number of follow-up visits within 6 months for common cardiovascular conditions at an academic health system.
MethodsElectronic health records data were extracted for general cardiology visits. New patient visits (NPVs) were included occurring from June 1, 2020, to May 31, 2023, for 10 common cardiovascular conditions—atrial fibrillation or flutter, chest pain, coronary artery disease, dyslipidemia, dyspnea, heart failure, hypertension, palpitations, preoperative evaluation, and syncope or dizziness. The effect of initial telemedicine versus in-person evaluation on follow-up visits within 6 months was assessed using a 2-stage least squares instrumental variable model with the proportion of clinician telemedicine use as the instrument and adjustment for patient and visit characteristics.
ResultsThere were 5528 NPVs conducted by 40 general cardiology clinicians during the study period. The average patient age was 56 (SD 17.5) years, 54.2% (2998/5528) were female, 43.2% (2389/5528) were non-Hispanic White, 24.7% (1368/5528) were Asian, 13.8% (761/5528) were Hispanic, 34.4% (1904/5528) were on Medicare, and 13.2% (729/5528) were on Medicaid. Of the NPVs, 53.5% (2959/5528) were conducted via telemedicine (2814/5528, 50.9% via video and 145/5528, 2.6% via phone). Telemedicine use for NPVs ranged from 0% to 100% (N=40) across individual clinicians. The average number of follow-up visits was 57 visits per 100 patients within 6 months across all diagnosis groups. Patients receiving telemedicine NPVs were more likely to have telemedicine follow-up visits than those receiving in-person NPVs (1354/1619, 83.6% vs 680/1533, 44.4%). In the instrumental variable analysis, the impact of initial telemedicine evaluation differed by presenting condition. There was an increase in follow-up visits for patients with syncope or dizziness (29.8 visits/100 patients, 95% CI 6.4-53.1), palpitations (34.9 visits/100 patients, 95% CI 18.6-51.1), chest pain (36.9 visits/100 patients, 95% CI 18.5-55.2), and dyspnea (37.0 visits/100 patients, 95% CI 11.8-62.0). There was a decrease in follow-up visits for patients with coronary artery disease (−29.5 visits/100 patients, 95% CI −50.3 to −8.6) and dyslipidemia (−24.5 visits/100 patients, 95% CI −40.2 to −8.8). There was no significant effect for patients presenting for atrial fibrillation or flutter, heart failure, hypertension, and preoperative evaluation.
ConclusionsThe effect of initial telemedicine evaluation on follow-up visits varied significantly by presenting condition in this cardiology practice. Telemedicine use resulted in increased follow-up visits for patients presenting with symptomatic complaints, while for those presenting with chronic conditions, there was no significant effect or a decrease in visits. Future studies should assess strategies to target initial care modalities to appropriate patients in cardiology clinics with early in-person evaluation for symptomatic patients. |
| format | Article |
| id | doaj-art-9687976e311e453eab4942e054729417 |
| institution | Kabale University |
| issn | 1438-8871 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | Journal of Medical Internet Research |
| spelling | doaj-art-9687976e311e453eab4942e0547294172025-08-20T04:01:48ZengJMIR PublicationsJournal of Medical Internet Research1438-88712025-08-0127e73509e7350910.2196/73509Impact of Initial Cardiology Telemedicine Evaluation on Follow-Up Visits for Common Conditions: Quasi-Experimental StudyNeil M Kalwanihttp://orcid.org/0000-0003-0075-6206Harrison Kooshttp://orcid.org/0000-0003-3051-5948Emily Kohnhttp://orcid.org/0000-0002-8540-6311Vijaya Parameswaranhttp://orcid.org/0000-0002-0984-9938Anica Oesterlehttp://orcid.org/0009-0000-0003-9464Marina Adrianzenhttp://orcid.org/0009-0002-1849-6190Febri Kurniawanhttp://orcid.org/0009-0004-6487-4425Lubna Qureshihttp://orcid.org/0009-0009-9365-4014Rajesh Dashhttp://orcid.org/0000-0002-2499-6389Paul Heidenreichhttp://orcid.org/0000-0001-7730-8490David Scheinkerhttp://orcid.org/0000-0001-5885-8024Fatima Rodriguezhttp://orcid.org/0000-0002-5226-0723 Abstract BackgroundTelemedicine use has increased significantly in cardiology clinics, but the impact of initial telemedicine evaluation on total visit usage is unknown. ObjectiveThis study aimed to determine the effect of initial telemedicine evaluation on the number of follow-up visits within 6 months for common cardiovascular conditions at an academic health system. MethodsElectronic health records data were extracted for general cardiology visits. New patient visits (NPVs) were included occurring from June 1, 2020, to May 31, 2023, for 10 common cardiovascular conditions—atrial fibrillation or flutter, chest pain, coronary artery disease, dyslipidemia, dyspnea, heart failure, hypertension, palpitations, preoperative evaluation, and syncope or dizziness. The effect of initial telemedicine versus in-person evaluation on follow-up visits within 6 months was assessed using a 2-stage least squares instrumental variable model with the proportion of clinician telemedicine use as the instrument and adjustment for patient and visit characteristics. ResultsThere were 5528 NPVs conducted by 40 general cardiology clinicians during the study period. The average patient age was 56 (SD 17.5) years, 54.2% (2998/5528) were female, 43.2% (2389/5528) were non-Hispanic White, 24.7% (1368/5528) were Asian, 13.8% (761/5528) were Hispanic, 34.4% (1904/5528) were on Medicare, and 13.2% (729/5528) were on Medicaid. Of the NPVs, 53.5% (2959/5528) were conducted via telemedicine (2814/5528, 50.9% via video and 145/5528, 2.6% via phone). Telemedicine use for NPVs ranged from 0% to 100% (N=40) across individual clinicians. The average number of follow-up visits was 57 visits per 100 patients within 6 months across all diagnosis groups. Patients receiving telemedicine NPVs were more likely to have telemedicine follow-up visits than those receiving in-person NPVs (1354/1619, 83.6% vs 680/1533, 44.4%). In the instrumental variable analysis, the impact of initial telemedicine evaluation differed by presenting condition. There was an increase in follow-up visits for patients with syncope or dizziness (29.8 visits/100 patients, 95% CI 6.4-53.1), palpitations (34.9 visits/100 patients, 95% CI 18.6-51.1), chest pain (36.9 visits/100 patients, 95% CI 18.5-55.2), and dyspnea (37.0 visits/100 patients, 95% CI 11.8-62.0). There was a decrease in follow-up visits for patients with coronary artery disease (−29.5 visits/100 patients, 95% CI −50.3 to −8.6) and dyslipidemia (−24.5 visits/100 patients, 95% CI −40.2 to −8.8). There was no significant effect for patients presenting for atrial fibrillation or flutter, heart failure, hypertension, and preoperative evaluation. ConclusionsThe effect of initial telemedicine evaluation on follow-up visits varied significantly by presenting condition in this cardiology practice. Telemedicine use resulted in increased follow-up visits for patients presenting with symptomatic complaints, while for those presenting with chronic conditions, there was no significant effect or a decrease in visits. Future studies should assess strategies to target initial care modalities to appropriate patients in cardiology clinics with early in-person evaluation for symptomatic patients.https://www.jmir.org/2025/1/e73509 |
| spellingShingle | Neil M Kalwani Harrison Koos Emily Kohn Vijaya Parameswaran Anica Oesterle Marina Adrianzen Febri Kurniawan Lubna Qureshi Rajesh Dash Paul Heidenreich David Scheinker Fatima Rodriguez Impact of Initial Cardiology Telemedicine Evaluation on Follow-Up Visits for Common Conditions: Quasi-Experimental Study Journal of Medical Internet Research |
| title | Impact of Initial Cardiology Telemedicine Evaluation on Follow-Up Visits for Common Conditions: Quasi-Experimental Study |
| title_full | Impact of Initial Cardiology Telemedicine Evaluation on Follow-Up Visits for Common Conditions: Quasi-Experimental Study |
| title_fullStr | Impact of Initial Cardiology Telemedicine Evaluation on Follow-Up Visits for Common Conditions: Quasi-Experimental Study |
| title_full_unstemmed | Impact of Initial Cardiology Telemedicine Evaluation on Follow-Up Visits for Common Conditions: Quasi-Experimental Study |
| title_short | Impact of Initial Cardiology Telemedicine Evaluation on Follow-Up Visits for Common Conditions: Quasi-Experimental Study |
| title_sort | impact of initial cardiology telemedicine evaluation on follow up visits for common conditions quasi experimental study |
| url | https://www.jmir.org/2025/1/e73509 |
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