From bedside to broadband: Evaluating outcomes of telehealth infectious diseases consultations

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Abstract Background Telemedicine is increasingly used to expand access to infectious diseases (ID) specialists but data on patient outcomes are limited. We compared patient outcomes of inpatient in-person ID consultations and tele-ID in a community hospital. Methods One of two community hospitals in our health system transitioned from in-person to telehealth ID consultation (tele-ID). We examined a retrospective cohort of patients receiving ID consultations in both hospitals before and after the transition while accounting for secular trends. Results A total of 3,223 patients received ID consultation in the telemedicine switch hospital (1,682 during the in-person period and 1,541 during the tele-ID period). Length of stay among patients receiving ID consultation did not differ between the pre-telehealth and telehealth periods (median 7 (IQR 4-13) vs. 7 (IQR 5-13) days, p=0.47). Similarly, 30-day readmission (17.4% vs. 17.7%, p=0.86), 30-day mortality (9.2% vs. 8.7%, p=0.65), and combined 30-day death/readmission (25.9% vs. 25.6%, p=0.88) did not differ between the pre-telehealth and telehealth periods. Multivariable modeling adjusting for age, sex, race, modified Charlson score, and hospital demonstrated no significant associations between receiving tele-ID care and 30-day readmission, death, or days dead/hospitalized within 90 days after the initial ID consultation. The mean number of computed tomography/magnetic resonance imaging studies during the index admission was significantly higher at the telehealth switch hospital during the telehealth period (2.28) than the pre-telehealth period (1.69, p<0.001 for comparison) Conclusions Transition to tele-ID was not associated with any increase in patient-relevant adverse outcomes but was associated with increased imaging utilization.