INTRODUCTION Providers and patients have expressed concern that care provided through telehealth results in poorer outcomes than traditional in-person care. On the contrary, we hypothesized that patients with cirrhosis engaging in video/phone-based outpatient gastroenterology/hepatology tele-visits do not differ in mortality from those receiving in-person outpatient clinic visits. METHODS This was a retrospective, case-control study using Veterans Health Administration administrative data of veterans with a cirrhosis diagnosis. Cases were patients who died between April 2021 and July 2022 and had a cirrhosis diagnosis for ≥1 year before death. For each case, a control was randomly selected from the pool of patients alive on the date of death of the case (index date) and matched on age, average Model for End-Stage Liver Disease, and number of gastroenterology/hepatology clinic visits in the prior year. Primary exposure variable was % tele-visits (video/phone) out of total visits in the year before the index date, scaled in 10% increments. Conditional logistic regression was used to assess the association between mortality and % tele-visits. A secondary analysis matched on electronic Child-Turcotte-Pugh score rather than Model for End-Stage Liver Disease. RESULTS Two thousand nine hundred thirty-three cases were identified and matched with 2,933 controls. After adjusting for covariates, tele-visit-based outpatient care was associated with a small reduction in mortality (odds ratio TH = 0.95, 95% confidence interval = 0.94-0.97). Matching on electronic Child-Turcotte-Pugh score did not change the results. DISCUSSION Our findings suggest that outpatient cirrhosis care by tele-visit is associated with outcomes no worse than traditional in-person visits. This should reassure providers who hesitate to provide virtual care to patients with cirrhosis due to concerns for poorer outcomes.

中文翻译：

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与传统的亲自就诊相比，通过远程就诊提供门诊肝硬化护理不会增加死亡率。


简介 提供者和患者都表示担心，通过远程医疗提供的护理结果比传统的面对面护理更差。相反，我们假设接受视频/电话门诊胃肠病学/肝病学远程就诊的肝硬化患者与接受面对面门诊就诊的患者的死亡率没有差异。方法 这是一项回顾性病例对照研究，使用退伍军人健康管理局对诊断为肝硬化的退伍军人的管理数据。病例为2021年4月至2022年7月期间死亡且死亡前诊断为肝硬化≥1年的患者。对于每个病例，从病例死亡日期（索引日期）时活着的患者池中随机选择一个对照，并根据年龄、终末期肝病的平均模型以及胃肠病学/肝病学门诊就诊次数进行匹配。前一年。主要暴露变量是索引日期之前一年内电话访问（视频/电话）占总访问次数的百分比，按 10% 的增量缩放。使用条件逻辑回归来评估死亡率和电话就诊百分比之间的关联。二次分析与电子 Child-Turcotte-Pugh 评分相匹配，而不是与终末期肝病模型相匹配。结果 识别出 2,933 例病例，并与 2,933 例对照进行匹配。调整协变量后，基于远程就诊的门诊护理与死亡率的小幅降低相关（比值比 TH = 0.95，95% 置信区间 = 0.94-0.97）。电子 Child-Turcotte-Pugh 评分的匹配并没有改变结果。讨论 我们的研究结果表明，通过电话就诊的门诊肝硬化护理的结果并不比传统的亲自就诊差。 这应该可以让那些因担心预后较差而犹豫是否为肝硬化患者提供虚拟护理的医疗服务提供者放心。