612 - In-Person vs Tele-Infectious Disease Care: Is One Better?

Background: Telemedicine (TM) has allowed physicians to expand beyond traditional in-person practice to provide care at remote locations. Initial performance of TM programs in ID has been reported, including favorable outcomes, but limited data exists on how inpatient Tele-ID compares to in-person.^1,2 To address this gap, we analyzed data from hospitals that transitioned from in-person ID care to Tele-ID.References


Methods: Travel time between the 3 rural Pennsylvania hospitals (total 432 inpatient beds) by car is 1 hour 40 minutes. All in-person consults were provided by an independent ID physician who traveled daily between sites. Starting July 2018, all consults were provided by Tele-ID consisting of one full-time equivalent physician. This included live audio-video visits and e-consults. Data were extracted from electronic health record; between 1/1/2018-6/30/2018 for in-person and 7/1/2018-12/30/2018 for Tele-ID. Key outcomes assessed were number of initial encounters, length of stay (LOS) after ID consult, proportions of patients discharged home, transferred to tertiary centers, and ID related readmission at 30 days.

Results: Study population consisted of 642 encounters with majority being Caucasian, female and average age 67 years (Table 1). Tele-ID had higher comorbidity scores vs in-person ID (Table 1). Total encounters were significantly greater for Tele-ID than in-person ID (Table 2; p=0.018). LOS after ID consult, transfers to tertiary centers, readmissions at 30 days, and discharges home were similar between the two groups (Table 2). Most common diagnosis was “bacteremia;” notably Tele-ID made a broader range of diagnosis (Figure 1). Limitations include a small sample size and possibility of a temporal bias, although the patient characteristics were similar except for higher co-morbidity for the Tele-ID service.Table 1: Characteristics of the Study Population
Table 2: Primary Outcomes of Consulted Patients
Figure 1: Wider variety of ID diagnosis by Tele-ID service


Conclusion: This comparative study shows that patient outcomes are similar between in-person and Tele-ID, despite higher volume and complexity encountered by Tele-ID. The greater number of consults and broader range of diagnosis made by Tele-ID suggests greater productivity, possibly related to travel time elimination. Tele-ID appears to be a good alternative solution for rural locations that lack in-person access to ID care.