Convergent Mixed Methods Exploration of Telehealth in Bariatric Surgery: Maximizing Provider Resources and Access
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Convergent Mixed Methods Exploration of Telehealth in Bariatric Surgery: Maximizing Provider Resources and Access Grace F. Chao 1,2,3
& Anne P. Ehlers
2,4,5
& Chad Ellimoottil
5,6
& Oliver A. Varban
4,5
& Justin B. Dimick
4,5
& Dana A. Telem
4,5
Received: 31 August 2020 / Revised: 5 October 2020 / Accepted: 13 October 2020 # This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2020
Abstract Background Telehealth may be an important care delivery modality in reducing dropout from bariatric surgery programs which is reported globally at approximately 50%. Methods In this convergent mixed methods case study of a large, US healthcare system, we examine the impact of telehealth implementation in 2020 on pre-operative bariatric surgery visits and provider perspectives of telehealth use. Results We find that telehealth was significantly associated with a 38% reduction in no-show rate compared with the prior year. Additionally, providers had positive experiences with regard to the appropriateness and feasibility of using telehealth in the preoperative bariatric surgery process. Conclusions Telehealth use in the pre-operative bariatric surgery process may lead to greater efficiency in healthcare resource utilization. Insurance providers and bariatric accreditation bodies globally should consider accepting telehealth visits and selfreported weights when determining coverage decisions to ensure access for patients. Keywords Telehealth . Bariatric surgery
Introduction Despite bariatric surgery being the only effective method for sustainable weight loss, it remains underutilized at less than 1% of eligible persons [1]. Even more concerning is that of those who initiate the bariatric surgery process; globally, nearly 50% will drop out prior to completing surgery [2–7]. Required time intensive workup and number of visits are two of the important factors associated with increased dropout [2, 8].
* Grace F. Chao [email protected] Anne P. Ehlers [email protected]
Telehealth allows patients to access care from their chosen location which can help incorporate health into the lives of patients, especially those who have other household and work responsibilities or who for other reasons have difficulty attending in-person visits. Thus, mechanisms of healthcare delivery like telehealth, which can potentially reduce the burden of visits, may improve follow-through. The COVID-19 pandemic provided a natural experiment to assess telehealth’s impact on pre-operative bariatric visits.
1
National Clinician Scholars Program, University of Michigan, 2800 Plymouth Road Building 14, Room G100, Ann Arbor, MI 48109, USA
2
Veterans Affairs Ann Arbor, Ann Arbor, MI, USA
3
Department of Surgery, Yale School of Medicine, New Haven, CT, USA
4
Department of Surgery, University of Michigan, Ann Arbor, MI, USA
5
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arb
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