Background:

The COVID-19 pandemic accelerated telemedicine use nationally, but differences across health systems are understudied. We examine telemedicine use for adults with diabetes and/or hypertension across ten health systems and analyze practice and patient characteristics associated with greater use.

Methods:

Encounter-level data from the AMGA Optum™ Data Warehouse for March 13, 2020 to December 31, 2020 were analyzed, which included 3,016,761 clinical encounters from 764,521 adults with diabetes and/or hypertension attributed to one of 1,207 practice sites with≥ 50 system-attributed patients. Linear spline regression estimated whether practice size and ownership were associated with telemedicine during the adoption (Weeks 0–4), de-adoption (Weeks 5–12), and maintenance (Week 13–42) periods, controlling for patient socioeconomic and clinical characteristics.

Results:

Telemedicine use peaked at 11% to 42% of weekly encounters after 4 weeks. In adjusted analyses, small practices had lower use for adults with diabetes during the maintenance period compared to larger practices. Practice ownership was not associated with telemedicine use. Practices with higher shares of Black patients continued to expand telemedicine use during the de-adoption and maintenance periods.

Conclusion:

Practice ownership was not associated with telemedicine use during first months of the pandemic. Small practices de-adopted telemedicine to a greater degree than medium and large sized practices. Technical support for small practices, irrespective of their ownership, could enable telemedicine use for adults with diabetes and/or hypertension.