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Your follow-up recommendation for a patient seen with a telehealth visit is often a diagnostic test or specialty referral. Completion of those follow-up recommendations—“diagnostic loop closure”—seems to be lacking, according to a study in JAMA Network Open. The study involved 4,133 diagnostic tests and referrals (colonoscopies, cardiac stress tests, and dermatology referrals) from March 2020 through December 2021 at 2 primary care sites. Results showed that 58% of in-person visit orders were completed within the designated time frame, while only 43% of telehealth visit orders were completed. The closure rate ranged from 40% to 65% for all test types, regardless of visit modality, and closure was defined within specific time frames (365 days for colonoscopy, 90 days for dermatology, and 45 days for cardiac stress tests). The study revealed that patients with telehealth visits were less likely to close the diagnostic loop compared to those with in-person visits.

There’s no way to get there from here: The authors say: “When investigating notable differences in loop closure for orders placed during telehealth visits, our findings suggest that differences in loop closure may be inherent to telehealth as a modality. One potential mechanism to explain this may be the lack of systems in place to help patients complete test and referral orders.” Indeed, passing along a referral provider’s phone number is rarely enough.

Patients Less Likely to Follow Up After Telehealth Visits
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