Characterization and Outcomes of Virtual Visit During the COVID-19 Pandemic

Abstract

Purpose : Telehealth has a variety of proposed uses in ophthalmology and has become a valuable asset to health care in the COVID-19 pandemic. This retrospective, observational study characterizes the use of virtual visits and compares the outcomes of these visits to in-person visits during the pandemic period at a large academic institution.

Methods : 2,943 virtual and 56,174 in-person visits occurring at Cole Eye Institute, Cleveland Clinic, were identified. A random sample of 3,000 in-person visits was selected for comparison. Canceled, incomplete and duplicated visits, as well as visits for patients aged less than 18 years old were excluded. Pearson's chi-square test of independence and test of proportions were used to assess relationships between categorical variables.

Results : 2,266 virtual visits and 2,590 in-person visits were included. The visits distribution across ophthalmology specialties is summarized in table 1. 72.3% of the virtual visits resulted in a planned follow-up compared to 70.3% following an in-person visit (p=0.121). 15.9% of virtual patients were discharged compared to 10.8% of in-person patients (p<0.001). 5.6% of virtual patients were referred to a primary care doctor or different ophthalmology subspecialty compared to 6.9% in-person patients (p=0.081). 6.0% of the patients had an outpatient surgery scheduled after a virtual visit compared to 4.8% in-person patients (p=0.08). 0.2% of the virtual patients had a clinic procedure scheduled compared to 7.2% in-person patients (p<0.001). Loss to follow-up occurred due to cancelations (4.6% and 3.5% in the virtual and in-person visits, respectively, p=0.11), no shows (2.8% and 2.1%, p=0.2) and no schedule (10.4% and 2.3%, p<0.001). 84.6% of the completed follow-up visits after virtual visits were in-person and 15.4% were virtual, in comparison to 97.4% and 2.6% after an in-person encounter (p<0.001).

Conclusions : The similar number of follow-up, referral and outpatient surgery outcomes across virtual and in-person visits suggests that teleophthalmology is a viable alternative for patient care. Virtual follow-ups occurred more often after a virtual visit. Discharges and unscheduled follow-up visits were also more prevalent in the virtual setting, implying a higher risk of care discontinuation in this group. Further research into the applications of telehealth for ophthalmology may be beneficial.

This is a 2021 ARVO Annual Meeting abstract.