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Abstract Details

Factors associated with utilization of telemedicine during the COVID-19 pandemic among patients with myasthenia gravis: A retrospective regional cohort study
Neuromuscular and Clinical Neurophysiology (EMG)
P11 - Poster Session 11 (11:45 AM-12:45 PM)
11-009

TMU data by patients with MG are limited. Effects of demographic characteristics on MG patients’ TMU and choice between VVV and AVO are unknown. 
1) Describe telemedicine utilization (TMU) during the COVID-19 pandemic among neurology outpatients with myasthenia gravis (MG); 2) Analyze characteristics of patients completing virtual video visits (VVV) compared to audio visits only (AVO). 

We performed a retrospective cohort study using Mass General Brigham’s (MGB) data warehouse. Inclusion criteria were: 1) adult patients with autoimmune MG (ICD10 code = G70.*); 2) ≥ 1 outpatient neurology encounter for MG among 4 MGB hospitals April 1, 2020 - March 31, 2021. Chart review excluded congenital myasthenic syndromes, Lambert-Eaton myasthenic syndrome and patients without a confirmed MG diagnosis.  Primary outcome was any TMU. Secondary outcome was proportion of telemedicine users achieving ≥ 1 VVV. EMR portal status was a proxy for digital literacy and access. Analyses included descriptive statistics, Chi Square test, and multivariable logistic regression.   

459 MG patients completed 1083 neurology encounters: 451 (41.6%) in-person, 481 (44.4%) VVV and 151 (13.9%) AVO. 336/459 (73.2%) achieved telemedicine utilization (TMU). Baseline patient characteristics (age, sex, race/ethnicity, language, state of residence, insurance, distance to neurologist, portal access) were not associated with TMU. Patients with a MGB PCP were less likely to participate in telemedicine (OR 0.60 [0.36-0.99]). Of 336 patients with TMU, 259 (77.1%) had ≥ 1 VVV, while 77 (22.9%) had AVO. The AVO group had a smaller proportion of white patients (76.6% vs.84.3%, p=0.031). In adjusted analysis, no characteristics remained associated with VVV achievement.   
During 1 year of COVID-19, this MG cohort had high utilization rates of TM (73.2%) and VVV (77.1%). Older age, non-English language and portal inactivity were not associated with lower rates of TMU and VVV. Future studies should assess regional variation and outcomes of TMU in MG. 
Authors/Disclosures
Amanda C. Guidon, MD (Massachusetts General Hospital)
PRESENTER 		An immediate family member of Dr. Guidon has received personal compensation for serving as an employee of GE Healthcare. Dr. Guidon has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Guidon has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Momenta. Dr. Guidon has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. The institution of Dr. Guidon has received research support from MGFA. The institution of Dr. Guidon has received research support from Project Data Sphere. The institution of Dr. Guidon has received research support from MGNet. The institution of Dr. Guidon has received research support from MGNet. Dr. Guidon has received publishing royalties from a publication relating to health care.
Jeff Guptill, MD, FAAN (argenx US) Dr. Guptill has received personal compensation for serving as an employee of argenx. Dr. Guptill has stock in argenx.
Michael K. Hehir II, MD (Larner College of Medicine at the University of Vermont) Dr. Hehir has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Argenx. Dr. Hehir has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Alexion. Dr. Hehir has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for UCB Pharma. Dr. Hehir has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Janssen. Dr. Hehir has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Immunovant. Dr. Hehir has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum- American Academy of Neurology. Dr. Hehir has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MedLink Neurology. The institution of Dr. Hehir has received research support from Myasthenia Gravis Foundation of America. The institution of Dr. Hehir has received research support from University of Vermont Medical Center.
No disclosure on file
No disclosure on file
No disclosure on file
Mahsa Eskian, MD (SUNY upstate) Dr. Eskian has nothing to disclose.
William S. David, MD, PhD, FAAN (EMG /Neuromuscular Unit) Dr. David has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Dysimmune Disorders foundation. Dr. David has received publishing royalties from a publication relating to health care.
James F. Howard, Jr., MD, FAAN (The University of North Carolina, Dept of Neurology, CB 7025) Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for arenx . Dr. Howard has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Regeneron Pharmaceuticals. Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ra Pharma (now UCB Biosciences). Dr. Howard has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. Dr. Howard has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi US. Dr. Howard has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Academic CME. Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for PeerView CME. Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Platform Q CME. Dr. Howard has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Zai Laboratories. Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Medscape CME. Dr. Howard has stock in General Electric dividends. Dr. Howard has stock in Johnson & Johnson dividends. Dr. Howard has stock in Pfizer dividends. An immediate family member of Dr. Howard has stock in GlaxoSmithKline dividends. An immediate family member of Dr. Howard has stock in GE Healthcare dividends. The institution of Dr. Howard has received research support from Alexion Pharmaceuticals. The institution of Dr. Howard has received research support from argenx . The institution of Dr. Howard has received research support from UCB Biosciences. The institution of Dr. Howard has received research support from NIH. The institution of Dr. Howard has received research support from Centers for Disease Control/Research Triangle Institute. The institution of Dr. Howard has received research support from Duke University (DCRI). The institution of Dr. Howard has received research support from Cartestian Therapeutics. Dr. Howard has a non-compensated relationship as a Scientific Advisiory Board member, Committee member with Myasthenia Gravis Foundation of America that is relevant to AAN interests or activities. Dr. Howard has a non-compensated relationship as a Committee member with American Assoc Neuromuscular and Electrodiagnostic Medicine that is relevant to AAN interests or activities.