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Original ArticleClinical Nephrology
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Provider Perspectives and Clinical Outcomes with Inpatient Telenephrology

Lagu A. Androga, Ziad Zoghby, Priya Ramar, Rachel H. Amundson, Margaret d’Uscio, Lindsey M. Philpot, Bjoerg Thorsteinsdottir, Andrea G. Kattah and Robert C. Albright
CJASN May 2022, 17 (5) 655-662; DOI: https://doi.org/10.2215/CJN.13441021
Lagu A. Androga
1Division of Nephrology & Hypertension, Mayo Clinic, Rochester, Minnesota
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Ziad Zoghby
1Division of Nephrology & Hypertension, Mayo Clinic, Rochester, Minnesota
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Priya Ramar
2Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Rachel H. Amundson
1Division of Nephrology & Hypertension, Mayo Clinic, Rochester, Minnesota
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Margaret d’Uscio
1Division of Nephrology & Hypertension, Mayo Clinic, Rochester, Minnesota
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Lindsey M. Philpot
3Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Bjoerg Thorsteinsdottir
3Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Andrea G. Kattah
1Division of Nephrology & Hypertension, Mayo Clinic, Rochester, Minnesota
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Robert C. Albright Jr.
1Division of Nephrology & Hypertension, Mayo Clinic, Rochester, Minnesota
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Abstract

Background and objectives Despite the dramatic increase in the provision of virtual nephrology care, only anecdotal reports of outcomes without comparators to usual care exist in the literature. This study aimed to provide objective determination of clinical noninferiority of hybrid (telenephrology plus face-to-face) versus standard (face-to-face) inpatient nephrology care.

Design, setting, participants, & measurements This retrospective study compares objective outcomes in patients who received inpatient hybrid care versus standard nephrology care at two Mayo Clinic Health System community hospitals. Outcomes were then additionally compared with those patients receiving care at another Mayo Clinic Health System site where only standard care is available. Hospitalized adults who had nephrology consults from March 1, 2020 to February 28, 2021 were considered. Regression was used to assess 30-day mortality, length of hospitalization, readmissions, odds of being prescribed dialysis, and hospital transfers. Sensitivity analysis was performed using patients who had ≥50% of their care encounters via telenephrology. Structured surveys were used to understand the perspectives of non-nephrology hospital providers and telenephrologists.

Results In total, 850 patients were included. Measured outcomes that included the number of hospital transfers (odds ratio, 1.19; 95% confidence interval, 0.37 to 3.82) and 30-day readmissions (odds ratio, 0.97; 95% confidence interval, 0.84 to 1.06), among others, did not differ significantly between controls and patients in the general cohort. Telenephrologists (n=11) preferred video consults (82%) to phone for communication. More than half (64%) of telenephrologists spent less time on telenephrology compared with standard care. Non-nephrology hospital providers (n=21) were very satisfied (48%) and satisfied (29%) with telenephrology response time and felt telenephrology was as safe as standard care (67%), while providing them enough information to make patient care decisions (76%).

Conclusions Outcomes for in-hospital nephrology consults were not significantly different comparing hybrid care versus standard care. Non-nephrology hospital providers and telenephrologists had favorable opinions of telenephrology and most perceived it is as safe and effective as standard care.

Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_04_11_CJN13441021.mp3

  • telenephrology
  • telehealth
  • inpatient nephrology
  • outcomes
  • patient perspectives
  • prospective studies
  • Received October 9, 2021.
  • Accepted March 15, 2022.
  • Copyright © 2022 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 17 (5)
Clinical Journal of the American Society of Nephrology
Vol. 17, Issue 5
May 2022
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Provider Perspectives and Clinical Outcomes with Inpatient Telenephrology
Lagu A. Androga, Ziad Zoghby, Priya Ramar, Rachel H. Amundson, Margaret d’Uscio, Lindsey M. Philpot, Bjoerg Thorsteinsdottir, Andrea G. Kattah, Robert C. Albright
CJASN May 2022, 17 (5) 655-662; DOI: 10.2215/CJN.13441021

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Provider Perspectives and Clinical Outcomes with Inpatient Telenephrology
Lagu A. Androga, Ziad Zoghby, Priya Ramar, Rachel H. Amundson, Margaret d’Uscio, Lindsey M. Philpot, Bjoerg Thorsteinsdottir, Andrea G. Kattah, Robert C. Albright
CJASN May 2022, 17 (5) 655-662; DOI: 10.2215/CJN.13441021
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