(28) Adoption of Telehealth in the Oral Maxillofacial Surgery Clinic

Abstract: On March 11th, 2020, the World Health Organization defined COVID-19 as a pandemic [1]. From March 18th to April 27th, 2020, following expert recommendations from the Centers for Medicare and Medicaid Services (CMS), many states issued executive orders to restrict all procedures that were non-emergent [2]. Resource limitation and quarantine policies also affected the care of patients with non-COVID-19 related conditions such as those seen in the Department of Oral Maxillofacial Surgery. Telehealth became an integral part of many healthcare systems to continue the provision of care. This study aims to evaluate the impact of COVID-19 on the utilization of telehealth in Oral Maxillofacial Surgery.

This is a retrospective descriptive study of patients presenting to the Oral Maxillofacial Surgery Department outpatient clinic at the University of Pennsylvania between March 1st, 2020, and March 1st, 2021. Source data (13,027 encounters) were obtained from EPIC, an electronic medical record application. Data were graphed using Tableau and Microsoft Excel Software. The primary predictor variable included the number of cases in Philadelphia as a proxy for the severity of the pandemic by month, and the primary outcome variable is the frequency of telehealth visits based on visit types (new patient versus return patient). Covariates include patient demographics, including age, race, and sex, as well as the encounter diagnosis.

The number of telehealth visits does not correlate with the severity of the pandemic, rather, it directly reflects policy implementation such as the lockdown and prohibition of elective procedures and visits. During the time of the study in Pennsylvania, the peak incidence rate occurred on December 16th, at a rate of 10,190 new infections. In-person visits experienced a precipitous drop in the month of April 2020 following the restriction of non-emergent service, from 100% to 71.1% for new patients, and 92.1% to 5.3% for return patients (Figure 1). The largest percentage of telehealth visits were between the ages of 30 to 39, 40 to 49, and 50 to 59 years old at 16% for each group and were lowest at 11% in ages 70 to 79, and 9% in those ages 18 and 19 years old (Figure 2). The two groups with the highest percentage of telehealth visits were patients that identified as White and Other at 15%, followed by patients who identified as Asian at 14%, and Black at 11%. Sixteen percent of female patients utilized telehealth visits, while 11% of male patients utilized telehealth visits. The diagnosis coded at the highest frequency during this period was lichen planus at 81 encounters, followed by myofascial muscle pain (65), articular disc disorder of the temporomandibular joint (48), surgery follow-up (41), joint replacement (39), stomatitis and mucositis (35) drug-induced osteonecrosis of the jaw (35), tongue dysplasia (32), acquired oral dysplasia (32), and other dystonia (30) (Figure 3).

Effective implementation of policies is the best method to mitigate the effect of COVID-19 and directly influence the utilization of telehealth. Telehealth encounters allowed the continued provision of care during the pandemic. Future studies should focus on the protocolization of telehealth using technology to expand diagnostic capabilities and improve the quality of remote care.
References
1. World Health Organization (WHO) (2020) Coronavirus disease 2019 situation report 51. In: World Heal Organ. https://www.who.int/ emergencies/diseases/novel-coronavirus-2019. Accessed 4 Jan 2022
2. State guidance on elective surgeries. In: Ambul. Surg. Cent. Assoc. ASCA Found. https://www.ascassocia-tion.org/asca/resourcecenter/latestnewsresourcecenter/covid-19/covid-19-state. Accessed 4 Jan 2022

Figure 1. Monthly breakdown of both Telehealth and in-person visits from March 2020 to March 2021 (n = 13,027).
Figure 2. Age distribution of patient encounters through either Telemedicine or in-person visits (n = 13,027).
Figure 3. Most common encounter diagnoses.