Kaiser Permanente study finds video or telephone visits comparable to in-person visits for new cardiology patients
Between 2020 and 2022, thousands of Kaiser Permanente Northern California (KPNC) members with symptoms possibly linked to heart conditions received a first-time referral to a cardiologist from their primary care doctor. A new study finds that, for these patients, an initial appointment with a cardiologist by video or telephone was as safe and efficient as an in-person office visit.
“We were reassured to see that telemedicine was comparable with in-person visits in the hands of our cardiologists,” said lead author Scott Casey, MD, MS, a former delivery science fellow at the Kaiser Permanente Division of Research (DOR) and an emergency medicine physician with The Permanente Medical Group. “Our research suggests that telemedicine is meeting the needs of our newly referred cardiology patients.”
The study, published in JAMA Network Open, looked at the electronic health records of 5,735 adult KPNC members with a first-time cardiology referral for cardiology-related symptoms that had not yet led to a specific diagnosis, such as heart failure, coronary artery disease, or atrial fibrillation. Of those patients, 4,064 opted for a telemedicine visit with the cardiologist.
The researchers found that patients who had a telemedicine appointment with a cardiologist had fewer follow-up cardiology appointments and received a cardiology diagnosis just as quickly as those who saw a cardiologist for a traditional in-person visit. In addition, patients who used telemedicine were no more likely to visit the emergency department or to be hospitalized within 30 days of their cardiology appointment.
“Telemedicine is well-accepted by both patients and providers and can often offer more convenient health care access,” said senior author Mary Reed, DrPH, a DOR research scientist. “This finding in cardiology adds to the growing body of Kaiser Permanente virtual care research indicating that telemedicine meets patients’ medical needs across a variety of clinical areas.”
KPNC members have been able to choose among video, telephone, or in-person primary care visits since 2016. Since then, DOR investigators have been studying and comparing outcomes of the different care delivery methods. When the COVID-19 pandemic triggered a rapid surge in the use of telemedicine throughout Kaiser Permanente — and around the world — this work expanded.
“Kaiser Permanente has long been a pioneer in telemedicine, and we continue to evaluate it as it evolves,” Reed said. “We are interested in ways that telemedicine can offer patients access to care without compromising the clinical benefit of an in-person encounter with their physician.”
Our research suggests that telemedicine is meeting the needs of our newly referred cardiology patients.
— Scott Casey, MD, MS
Earlier KPNC studies found that telemedicine visits provide safe, timely care for adult and pediatric primary care patients. The new study is the first to focus on a narrower group of patients — those referred to a specialist — who may be at a much higher risk of serious outcomes.
“There is wide agreement that telemedicine is generally useful for follow-up visits when the patient already has an established relationship with the physician,” Reed said. “But we really wanted to look at a more challenging clinical scenario and ask, can you safely see your cardiologist for the first time for a new and emerging problem via telemedicine? The answer appears to be, ‘yes.’”
To help rule out possible alternative explanations for the findings, the researchers statistically accounted for factors such as age, high blood pressure, and socieconomic status.
They also dug deeper into the data by categorizing the patients according to the suspected diagnosis suggested by their initial symptoms. This step revealed that patients with suspected coronary artery disease who had a telemedicine visit had a lower risk of visiting the emergency department within the next 30 days than those who came in person.
“Overall our findings suggest that Kaiser Permanente members with potentially heart-related symptoms who are referred to a cardiologist for the very first time can be reassured that a telemedicine visit is comparable to coming to an in-person clinic visit, both in terms of safety and efficiency,” said Alan Go, MD, co-author of the study and associate director at DOR, where he leads the Cardiovascular, Kidney, and Metabolic Health Research Section.
Although the findings support the use of telemedicine for first-time cardiology referrals within KPNC’s integrated health care model, the researchers noted that this does not mean the same results would necessarily be seen in other health care settings.
“Our study does not necessarily directly generalize to cardiology care delivered outside of our system,” Reed said. “However, it could serve as an encouraging example that telemedicine can efficiently support access to cardiology referrals.”
Added Casey: “It’s clear that telemedicine is emerging as an important way to deliver health care and we must continue to study its strengths and limitations.”
The study was funded by the Garfield Memorial Fund.
Co-authors include Andrew Huang, PhD, Madeline Sommers, MPH, MS, Jie Huang, PhD, Andrea Millman, MA, Elisha Garcia, BS, Deborah Low, BS, and Douglas Roblin, PhD, of the Division of Research; and Matthew Solomon, MD, PhD, of the Sutter Health Research Institute.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. KPDOR seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 720-plus staff, including 73 research and staff scientists, are working on nearly 630 epidemiological and health services research projects. For more information, visit divisionofresearch.kp.org.
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