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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

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:

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