Presentation Authors: Julia Finkelstein*, Dylan Cahill, Kate Humphrey, Caleb Nelson, Carlos Estrada, Boston, MA
Introduction: As the use of telemedicine expands, it is important to assess its impact on safety and quality of care as well as costs. Outcomes from virtual visits (VV), remote encounters via a video system, have not been evaluated in the postoperative pediatric urology population. We sought to compare VV with in-person visits (IPV) with respect to clinical outcomes and family experience.
Methods: A prospective study was conducted of VV and IPV during a 2 month period in 2018. Postoperative patients of 8 pediatric urologists were enrolled. The following variables were tracked: appointment compliance, waiting room and visit time, and the number of unscheduled encounters and readmissions. After each postoperative visit, families were asked to complete an electronic 11-question survey pertaining to their experience, including quantifying direct cost, missed work and school, and their satisfaction. Opportunity cost was estimated by multiplying reported missed work time by an average hourly wage of $22.81 (US Bureau of Labor Statistics).
Results: 51 VV and 57 IPV were completed. There was no difference in the characteristics of the 2 cohorts (Table). Waiting room time for IPV was significantly longer (p < 0.001), with IPV starting a mean of 20 minutes after the scheduled time as compared to a mean VV start of 1.8 minutes prior to the scheduled time. VV face-to-face time spent with the urologist was significantly longer by 1.5 minutes (p=0.024). There was no difference in unscheduled encounters and there were no readmissions in either cohort.The survey response rate was 54% in both cohorts. Families reported that VV took 15 minutes, compared to almost 3 hours for IPV (p < 0.001). To participate in VV, significantly less work and school was missed by parents and children, respectively. Families incurred significantly greater direct (p < 0.001) and opportunity (p=0.0025) costs for IPV, totaling $108.23 on average per visit. Nearly all families (97-98%) were very satisfied or satisfied with their postoperative visit, whether it was virtual or in-person.
Conclusions: For pediatric urologic postoperative care, VV are associated with shorter wait and travel times, decreased missed work and school, and similar clinical outcomes compared to IPV. Telemedicine also reduces direct and opportunity costs associated with these brief but important encounters.