Clinical Report: Comparing In-person and Daily Telemedicine Infectious Disease Care
Overview
This retrospective study compared outcomes of 100 patients receiving periodic in-person infectious disease (ID) care versus 100 patients receiving daily Tele-ID care at a community hospital. Despite higher comorbidity scores in the Tele-ID group, length of stay was shorter, intravenous antibiotic use at discharge was reduced, and mortality rates were similar. Tele-ID care increased utilization of ID services without compromising patient safety.
Background
Access to infectious disease specialists is limited in most US counties, particularly in rural areas, affecting over 200 million people. Infectious disease consultation improves outcomes in serious infections but is often unavailable in community hospitals due to geographic and workforce constraints. Telemedicine offers a potential solution to provide timely ID expertise remotely. However, comparative data on the effectiveness of Tele-ID versus in-person care remain scarce. This study evaluates clinical outcomes between periodic in-person ID consultations and daily Tele-ID services at a 164-bed community hospital.
Data Highlights
Outcome
Periodic In-person ID Care (n=100)
Daily Tele-ID Care (n=100)
P Value
Charlson Comorbidity Index (mean)
4.5
5.3
0.047
Length of Stay (days, mean)
9.08
7.5
0.003
Discharge on IV Antibiotics (%)
51%
34%
0.007
Discharge on Oral Antibiotics (%)
23%
39%
0.014
Transfer to Tertiary Care (%)
14%
13%
0.84
In-hospital Mortality (%)
2%
2%
NS
30-day Readmission Rate (%)
1%
11%
<0.01
Key Findings
Patients receiving daily Tele-ID care had significantly higher Charlson Comorbidity Index scores (5.3 vs 4.5; P = .047), indicating greater baseline illness severity.
Length of hospital stay was significantly shorter in the Tele-ID group (7.5 vs 9.08 days; P = .003).
Discharge on intravenous antibiotics was less frequent with Tele-ID care (34% vs 51%; P = .007), while discharge on oral antibiotics was more common (39% vs 23%; P = .014).
No significant differences were observed in transfer rates to tertiary care facilities (13% vs 14%; P = .84) or in-hospital mortality (2% in both groups).
The 30-day readmission rate was higher in the Tele-ID group (11% vs 1%; P < .01), but only one readmission was related to infectious disease (Clostridioides difficile infection).
Tele-ID care led to increased utilization of infectious disease consultations and identified a similar diversity of diagnoses, with more tickborne illnesses diagnosed via Tele-ID.
Clinical Implications
Daily Tele-ID services can effectively expand access to infectious disease expertise in community hospitals lacking in-person specialists. Despite patients having higher comorbidity burdens, Tele-ID care was associated with shorter hospital stays and reduced use of intravenous antibiotics at discharge without increasing mortality or ID-related readmissions. Telemedicine may be a viable alternative to periodic in-person consultations, improving care delivery in resource-limited settings.
Conclusion
Daily Tele-ID care at a community hospital increased infectious disease consultation utilization and achieved comparable or improved clinical outcomes compared to periodic in-person care. These findings support Tele-ID as a practical solution to address specialist access gaps in underserved areas.
References
Walensky et al 2020 -- Infectious Disease Physician Distribution in US Counties
Armstrong Center for Medicine and Health Study 2020 -- Evaluating In-person Infectious Disease Care Versus Daily Telemedicine Services
Infectious Diseases Society of America 2020 -- Telehealth Use in Infectious Diseases
Large claims analysis finds no significant differences in serious infections, blood clots, or major cardiovascular events across biologics and a Janus kinase inhibitor.
