Direct to Consumer Strategies
EP-128 - Characteristics of Unresolved E-Visits in an Acute Care Telemedicine Program
Monday, April 30
9:55 AM - 10:10 AM
Location: Education Zone, Booth 2416, Screen 3
Context: Electronic visits (e-visits) are asynchronous electronic interactions between patients and providers through a secure patient portal. An e-visit program was implemented in December 2015 at the Medical University of South Carolina in Charleston, South Carolina to provide non-emergent acute care. As this new method of patient care continues to grow in use and develop into more areas of medical care, the quality of these visits remains of significant interest to insurers, healthcare systems, healthcare providers and to patients themselves. Studies often examine and present findings from e-visit programs in which the visits were resolved (ie the patient's problem was addressed, and they were billed for the encounter). There is limited information on the reasons why E-visits may remain unresolved, such as patient factors, severity of illness, and appropriateness of presenting complaints. In an effort to continually improve the quality of e-visits provided at our institution, we take the unique approach of analyzing factors associated with unresolved e-visits.
Methods: This study involves a retrospective chart review of 1575 e-visits submitted by adults ( > 18 years old) from December 2015 to July 2017. Patients could request e-visits for more than 20 common acute conditions, which include heartburn, diarrhea, influenza, rash, red eye, sinus problems, urinary problems, and vaginal irritation.
Descriptive statistics evaluating the characteristics of all e-visits as well as those which were not resolved were calculated. Chi-square tests were used to compare resolved and unresolved e-visits, evaluating differences between patient factors (age, gender), disease factors (condition being evaluated), and e-visit factors (response time, time the e-visit was submitted) All analyses were performed using SPSS.
Results: A total of 1575 e-visits were submitted from 18 December 2015 to 9 July 2017. Most e-visit were submitted by women (80.1%) and patients 18-45 years old (57.7%). One-fourth of patients (25.7%) submitted more than on e-visit. Most e-visits were successfully completed (92.5%). E-visits that could not be completed were more likely to be submitted by men than women (10.5% vs 6.4%, p=0.12), patients > 65 years old (6.6% for patients 18-45, 7.2% for patients 46-64, 13.5% for patients 65 and older, p=0.046), and have a response time over 20 minutes (12.4% vs 5.2%, p <0.001). Almost one-fifth of skin problems were not completed (18.1%), which was statistically significant (p<0.001).
Conclusions: Most submitted e-visits were resolved. For those that went unresolved, patients were more likely to be men and older. Rash and other skin problems were the most likely presenting condition in the e-visits to be unresolved. Improvement in e-visit resolution rates may require amending the e-visit template to obtain more information (eg more precise questions and requiring a photo). A variety of reasons could be associated with men and older patients having a lower resolution rate. For instance, these patients may have more complex conditions, they could be providing less information through the e-visit questionnaires, or providers may feel less comfortable treating older and male patients because of perceived worse health. Thus, further evaluation of the underlying causes for our findings is needed.
- Describe the prevalence of unresolved e-visits for acute conditions
- Identify factors associated with unresolved acute e-visits
- Formulate strategies to reduce the number of unresolved e-visits for acute conditions