Evaluation of virtual visits for plagiocephaly
Alex Cappitelli, Olivia Langa, Laura Nuzzi, Oren Ganor, Carolyn Rogers-Vizena, Ingrid Ganske
Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, MA
Purpose: At our institution, patients with deformational plagiocephaly are recommended to consult with a craniofacial plastic surgeon to evaluate the need for orthotic helmeting. In the past year, these visits were performed predominantly with telehealth, given the constraints of COVID-19. This study compares costs and patient/provider experiences for telehealth and in-person consultations for plagiocephaly.
METHODS: This is a prospective study of patients within the first year of life with deformational plagiocephaly treated between August 2020 and January 2021 via telehealth or in-person consultations at Boston Childrenís Hospital. Costs were measured using time-driven activity based costing. Personnel costs, facility costs, and travel expenses were included. Only consults for which timings of all steps in care were recorded were included; patients were excluded if any timings were not captured. Patientsí families and providers were administered post-visit questionnaires to assess satisfaction with the consult and any technical issues encountered. Paired provider and patient experience questionnaires were analyzed for consults in which both provider and family surveys were completed.
RESULTS: Costing analysis was performed on 20 telehealth consults and 11 in-person consults. Median total personnel and facilities cost of providing an in-person or telehealth consult were comparable (P>.05). Telehealth visits saved on the cost of clinical space, but required significantly more of the surgeonís time compared to in-person visits (P.05).
CONCLUSIONS: The largest component of cost differential between telehealth and in-person plagiocephaly consultations is the patient-borne cost associated with on-site visits (i.e. mileage, parking costs). Although the cost of clinical space was minor for each visit, in aggregate, for a large volume craniofacial center, the program-wide impact could be notable. Despite almost one-third of telehealth visits experiencing technical difficulties, there was high overall satisfaction with both models of care. Practices that manage patients with plagiocephaly may wish to consider expanding their virtual consult volume.
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