June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
In-State versus Out-of-State Ophthalmic Telemedicine Utilization during the COVID-19 Pandemic
Author Affiliations & Notes
  • Kanza Aziz
    Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Jade Yunkyung Moon
    Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
  • Anjali Devgan
    Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
  • Alice Lorch
    Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
  • David S Friedman
    Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
  • John B Miller
    Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
  • Grayson Wilkes Armstrong
    Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Kanza Aziz None; Jade Moon None; Anjali Devgan None; Alice Lorch Regeneron, Code C (Consultant/Contractor); David Friedman W.L. Gore and Associates, Code C (Consultant/Contractor), Bausch and Lomb, Code C (Consultant/Contractor), Thea Pharmaceuticals, Code C (Consultant/Contractor), Life Biosciences, Code C (Consultant/Contractor), Zeiss Meditec, Code F (Financial Support), Genentech Inc, Code F (Financial Support); John Miller Alcon, Code C (Consultant/Contractor), Allergan, Code C (Consultant/Contractor), Carl Zeiss, Code C (Consultant/Contractor), Sunovion, Code C (Consultant/Contractor), Genentech, Code C (Consultant/Contractor); Grayson Armstrong McKinsey & Company , Code C (Consultant/Contractor), Xenon-VR, Code C (Consultant/Contractor), Ophthalytics, Code C (Consultant/Contractor), Kriya Therapeutics, Code C (Consultant/Contractor), Ocular Technologies Inc, Code O (Owner), American Medical Association, Code S (non-remunerative)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 1407 – A0103. doi:
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      Kanza Aziz, Jade Yunkyung Moon, Anjali Devgan, Alice Lorch, David S Friedman, John B Miller, Grayson Wilkes Armstrong; In-State versus Out-of-State Ophthalmic Telemedicine Utilization during the COVID-19 Pandemic. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1407 – A0103.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose :
During the COVID-19 pandemic, regulatory changes in the United States allowed physicians to practice telemedicine across state lines. Data on the use of interstate ophthalmic telemedicine during the pandemic are limited. We aimed to evaluate the geographic characteristics and interstate utilization of telemedical care as compared to in-person care at a tertiary eye care center during the pandemic.

Methods :
In this single-center, retrospective, cross-sectional study at Massachusetts Eye and Ear (MEE) from January 1 to December 31, 2020, clinical encounters were reviewed to extract patient and visit characteristics. In-person versus telemedical visit types were identified based on institutional categories and billing codes. Residential zip codes were used to estimate geographic characteristics of patients including distance from MEE and in-state versus out-of-state status. Pearson chi-squared tests were used to compare telemedical and in-person care groups.

Results :
A total of 1911 telemedical patients (2262 encounters) and 65763 in-person patients (147211 encounters) were included. The median (interquartile range; IQR) age of telemedicine patients was 61 (43-72) years, 62% of which were female. The median (IQR) age of in-person patients was 63 (49-72) years, 58% of which were female. Telemedicine patients included 14.7% (n=281) out-of-state patients, as compared to 12.0% (n=7876) out-of-state in-person patients (p<0.001). Regarding distance, 42.5% of telemedicine patients and 47.5% of in-person patients lived <10 miles (p<0.001), 41.9% and 41.3% lived 10-50 miles (p=0.611), 8.8% and 7.0% lived 51-100 miles (p=0.002), 3.9% and 2.5% lived 101-250 miles (p<0.001), and 3.0% and 1.8% lived >250 miles (p<0.001) away from MEE, respectively.

Conclusions :
A significantly greater proportion of telemedical care, as compared to in-person care, was provided to out-of-state patients at a large eye care center during the pandemic. Moreover, a significantly greater proportion of telemedical care was utilized by patients living further away from the eye center. Proposals to revert to pre-pandemic policies requiring in-state telemedicine could set back forward progress made during the pandemic, including negative impacts on access to care and continuity of care for established patients. Expanded telemedicine licensure and scope could help advance the efficiency and deployment gains seen during the pandemic.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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