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Outcomes, Satisfaction, and Costs of a Rheumatology Telemedicine Program

A Longitudinal Evaluation

Wood, Patrick R. MD*†; Caplan, Liron MD, PhD*†

JCR: Journal of Clinical Rheumatology: January 2019 - Volume 25 - Issue 1 - p 41–44
doi: 10.1097/RHU.0000000000000778
Original Articles
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Objectives Rural veterans with inflammatory arthritis (IA) lack medical access because of geographic barriers. Telemedicine (TM) holds great promise in relieving these disparities. We have prospectively measured patient-centered data surrounding a TM care program at a federal health system and compared these with usual care (UC).

Methods Veterans with previously established IA were enrolled in TM follow-up. Data collected longitudinally before and after entering the program included Routine Assessment of Patient Index Data 3 (RAPID-3), out-of-pocket visit costs and distances traveled, and patient satisfaction instruments. Demographics were recorded. Similar data were collected on a convenience sample of concurrent IA patients receiving UC.

Results Eighty-five patients were observed, including 25 receiving TM care and 60 receiving UC. No differences in demographics, satisfaction scores, or RAPID-3 were noted at baseline between groups. Univariate linear regression of cross-sectional baseline data suggests satisfaction instrument scores were predicted by RAPID-3 (β = −0.64/10 points, p = 0.01), as well as distance (β = −0.19/100 miles, p = 0.02) and cost (β = −0.37/$100, p = 0.05). A multivariate model indicates both distance (β = −0.17/100 miles, p = 0.02) and RAPID-3 (β = −0.47/10 points, p < 0.03) were predictors for visit satisfaction. In longitudinal follow-up via TM, satisfaction (Δ = 0.03, p = 0.94) and RAPID-3 (Δ = 0.27, p = 0.89) remained similar to baseline among TM patients, whereas distance traveled (Δ = −384.8 miles/visit, p < 0.01) and visit costs (Δ = −$113.8/visit, p < 0.01) were reduced.

Conclusions Patient-reported outcomes for care delivered via TM were similar to UC, with significant cost and distance savings. Patient-centered factors such as distance to care should be considered in design care delivery models, as they appear to drive patient satisfaction in conjunction with disease control.

From the *Rocky Mountain Regional Veterans Affairs Medical Center; and

University of Colorado School of Medicine, Aurora CO.

L.C. is supported by VA HSR&D MERIT Award IIR 14-048-3. P.R.W. is supported by a VA GME Enhancement Award. Support for this project included funds from the US Department of Veterans Affairs Innovators Network.

The authors declare no conflict of interest.

Correspondence: Liron Caplan, MD, PhD, University of Colorado School of Medicine, PO Box 6511, B115, Denver, CO 80045. E-mail: liron.caplan@ucdenver.edu.

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