An Institutional Review Of COVID-19 Related Telemedicine Clinic Utilization And Its Effects On The Non-Invasive Vascular Laboratory
Matthew Schneck1, Sarah Ratcliffe, Ph.D.2, Bezhad Farivar, MD2, Margaret Tracci, MD, JD2, W. Darrin Clouse, MD2, John Kern, MD2, Carlin Williams, MD2.
1University of Virginia, Charlottesville, VA, USA, 2University of Virginia, CHARLOTTESVILLE, VA, USA.
OBJECTIVES: The COVID-19 pandemic has accelerated the implementation of telemedicine modalities as physical distancing is normalized. This increase in telemedicine clinic visits will have effects on associated ancillary services. The purpose of this study is to assess the impact of increased telemedicine clinic visits on noninvasive vascular laboratory visits. METHODS: Outpatient vascular surgery clinic patients were retrospectively analyzed between 2/12/2020 and 6/12/2020. This time period was one month before (2/12/20-3/12/20), two months during (3/13/20-5/11/20), and 1 month after (5/12/20-6/12/20) the implementation of Virginia’s COVID-19 hospital restrictions. The number of vascular laboratory visits resulting from in-person and telemedicine clinic visits during each time period was compared using Poisson regression. RESULTS: A total of 1,006 patients were seen in the vascular surgery outpatient clinic during the four months; 916 in-person and 90 telemedicine clinic visits. A total of 317 noninvasive vascular laboratory visits accompanied clinic visits; 294 lab visits from in-person and 23 from telemedicine clinic visits. The total number of clinic visits fell 40% and the number of vascular lab visits fell 56% with the introduction of COVID-19 restrictions. The percentage of telemedicine clinic visits increased from 0% pre-, to 11.7% during-, and 19.7% post COVID-19 restrictions. The percentage of lab visits from associated in-person clinic visits went from 33.7% pre-, to 25.6% during-, to 35.4% post COVID-19 restrictions. The percentage of telemedicine associated lab visits increased from 0% pre-, to 9.1% during-, to 16.7% post COVID-19 restrictions. There was no statistical difference in the rates of lab visits by clinic visit type (IRR=0.80, p=0.31). The overall percentage of lab visits with associated clinic visits was unchanged from 33.7% pre-, to 24.9% during-, to 34.1% post COVID-19 restrictions (chi-sq=5.6, p=0.061). CONCLUSIONS: As telemedicine clinic visits increased, the percentage of telemedicine clinic visits with associated lab visits increased. This increase trended toward the percentage of in-person clinic visits with associated lab visits seen in the pre-COVID era. This suggests that the combined percentage of in-person and remotely seen clinic patients getting vascular lab studies may be similar enough to keep vascular lab visits steady as we move to increase telemedicine utilization. 
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