The association between telemedicine use and changes in healthcare utilization and outcomes in patients with congestive heart failure: a retrospective cohort study (Preprint)
Bibliographic record
Abstract
BACKGROUND Telemedicine use has become widespread due to the COVID-19 pandemic, but how this has impacted patient outcomes remain unclear. OBJECTIVE We sought to investigate the effect of telemedicine use on changes in healthcare utilization and clinical outcomes in patients diagnosed with congestive heart failure. METHODS We conducted a population-based retrospective cohort study using administrative data in Ontario, Canada. Patients were included if they had at least one ambulatory visit between March 14, 2020 and September 30, 2020 and a heart failure diagnosis anytime prior to March 14, 2020. Telemedicine users were propensity score-matched with unexposed users based on several baseline characteristics. Monthly use of various healthcare services was compared between the two groups during 12 months before to 3 months after their index in-person or virtual ambulatory visit after March 14, 2020 using generalized estimating equations. RESULTS A total of 11,131 pairs of telemedicine and unexposed patients were identified after matching (49% male, mean(SD) age 78.9(12.0) years). All patients showed significant reductions in health service use from pre- to post-index visit. There was a greater decline across time in the unexposed group compared to the telemedicine group for CHF admissions (ratio of slopes for high vs low user (95% CI), 1.02 (1.02-1.03)), cardiovascular admissions (1.03 (1.02-1.04)), any-cause admissions (1.03 (1.02-1.04)), any-cause ED visits (1.03 (1.03-1.04)), visits with any cardiologist (1.01 (1.01-1.02)), lab tests (1.02 (1.02-1.03)), diagnostic tests (1.04 (1.03-1.05)), and new prescriptions (1.02 (1.01-1.03)). However, the decline in primary care visit rates was steeper among telemedicine patients than unexposed patients (ratio of slopes (95% CI), 0.99 (0.99-1.00)). CONCLUSIONS Overall healthcare utilization over time appeared higher among telemedicine users than low or non-users, suggesting that telemedicine was used among patients with the greatest need, or that it allowed patients to have better access and/or continuity of care among those who received it.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".