title: Virtual Visits for Upper Respiratory Tract Infections in Adults Associated with Positive Outcome in a Cox Model.
abstract: There is no previous work on the relationship between a virtual visit for viral upper respiratory tract infection and improved outcome, even though there is data on the prevalence and other descriptors. We do not know if a virtual visit is an independent prognostic factor in community-based patients. With the exponential growth of this type of clinical visit, it is important for both clinical and planning considerations to evaluate this question. We analyzed a cohort of adult patients with newly diagnosed viral upper respiratory tract infection from a database of health plan patients seen virtually on telemedicine and in person at urgent cares in Las Vegas, Nevada between January 2014 and September 2014. Logistic regression, Kaplan-Meier survival analysis, and Cox proportional hazard model were used. Among the final 6,756 patients selected with upper respiratory tract infections (median age of 41.5), 6% had virtual visits, while the rest were seen in person at urgent cares. Patients who had virtual visits were more likely to be younger, but had no other firm demographic differences from those seen for upper respiratory tract infections in urgent care. Hazard ratio for 2-week follow-up (= failure), with no significant effect from covariates, was 0.55 (confidence interval 0.324-0.939, p < 0.05) in virtual patients. In this cohort of patients with upper respiratory tract infection, a virtual visit, compared to an in-person one at urgent care, is an independent prognostic factor for less follow-up within 2 weeks. Further research into other age groups, time periods, and different diagnoses using similar methodology is warranted.
authors.affiliation: 1 On Demand Medicine, Southwest Medical , Part of OptumCare, Las Vegas, Nevada.
authors.forename: Lo Fu
authors.initials: LF
authors.lastname: Tan
authors.affiliation: 2 St. Rose Pediatrics , Henderson, Nevada.
authors.forename: Natalie
authors.initials: N
authors.lastname: Mason
authors.affiliation: 3 Health Informatics, United Health Group , Las Vegas, Nevada.
authors.forename: W James
authors.initials: WJ
authors.lastname: Gonzaga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods* / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009505:Nevada; D016016:Proportional Hazards Models; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000188:drug therapy*; D017216:Telemedicine / Q000706:statistics & numerical data*
chemical_list: D000900:Anti-Bacterial Agents
keywords: emergency medicine/teletrauma; medical records; telehealth; telemedicine