Author Of 1 Presentation
LB1161 - Teleneurology for MS care at two large academic centers before and during the-COVID-19 pandemic (ID 1394)
Abstract
Background
Teleneurology has the potential to improve patient access to specialized multiple sclerosis (MS) centers. MS patients face multiple barriers to receiving in-clinic care including physical limitations, driving restrictions, and financial limitations. The COVID-19 pandemic further highlighted the need to re-evaluate healthcare delivery models.
Objectives
To describe the teleneurology populations at two large MS centers (Cleveland Clinic (CC) and University of California, San Francisco (UCSF)) and the changes that occurred in teleneurology use before and during the COVID-19 pandemic.
Methods
In this cross-sectional study we identified all teleneurology visits conducted at our two centers between 01-2019 and 04-2020. We compared group demographics, visit characteristics, and MS disease characteristics using T-tests and chi-squared tests for normally distributed variables and Kruskal-Wallis test for non-parametric variables.
Results
2268 patients completed 2579 teleneurology visits during the study period across the two sites (mean age 48.3±12.3 years, 72.9% female); 78.1% had an MS diagnosis. Among MS patients, age and sex were similar (p>0.1 for each) but a greater proportion of patients seen at UCSF were non-white (74.8% vs 87% white, p=<0.001), had RRMS (78.7% vs 74.5%, p=.015), were on infusible DMTs (45.5% vs 35.2%, p=<0.001), walked independently (78.4% vs 72.7% p=<0.001), and lived closer to the Center (50.0 vs 57.2 miles, p=<0.005). CC had a higher proportion of advanced practice providers (APP) conducting visits (62.3% vs 2.6%, p=<0.001) and new patient visits (15.4% vs 4.0% p=<0.001). The post-COVID population (patients seen after March 15) across both sites had a higher proportion of African Americans (12.7% vs 5.0%, p=<0.001) and shorter driving distance (35.6 vs 130 miles, p=<0.001) compared to the pre-COVID population. The populations pre- and post-COVID did not differ on sex, current DMT, disease course, or disability level.
Conclusions
Teleneurology visits at baseline reflected the organizational and teleneurology reimbursement patterns across our Centers. Following precautionary measures and expanded reimbursement for telemedicine associated with the COVID-19 pandemic, we significantly increased utilization of specialized MS teleneurology care for local and African American patients. These findings illustrate the potential for societal factors to rapidly change disparities in technology adoption and access to specialized MS care.