Patient characteristics associated with the successful transition to virtual care: Lessons learned from the first million patients.

INTRODUCTION: The increased use of telehealth to maintain ambulatory care during the COVID-19 pandemic had potential to exacerbate or diminish disparities in access to care. OBJECTIVE: The purpose of this study was to describe patient characteristics associated with successful transition from in-person to virtual care, and video vs audio-only participation. METHODS: This was a retrospective analysis of electronic health record data from all patients with ambulatory visits from 1 October 2019-30 September 2020 in a large integrated health system in the Northeast USA. The outcome of interest was receipt of virtual care, and video vs audio-only participation. We matched home addresses with census-tract level area social vulnerability index (SVI) and Internet access. Among ambulatory care patients, we used logistic regression to identify characteristics associated with virtual participation. Among virtual participants, we identified characteristics associated with video vs audio-only visits. RESULTS: Among 1,241,313 patients, 528,542 (42.6%) were virtual participants. Relative to in-person only, virtual participants were older, more often English-proficient and with activated patient portal. Characteristics associated with virtual participation included patients with: only behavioural health visits, COVID patients, highest quartile of visit frequency, and multiple visit types. Characteristics associated with video participation (relative to audio-only) included being younger and patients with: only behavioural health visits, highest quartile of visit frequency, non-Hispanic black race, limited English proficiency and inactivated portal account. DISCUSSION: In our regional healthcare system, the transition to virtual care during COVID was vital for continued access to care, but substantial inequity remained. Without audio-only visits, access to care would have been even more limited for our most vulnerable patients.

Regional Changes in Patterns of Stroke Presentation During the COVID-19 Pandemic.

[Figure: see text].

Removal kinetics of petroleum hydrocarbons from low-permeable soil by sand mixing and thermal enhancement of soil vapor extraction.

Thermally enhanced remediation of n-alkanes-contaminated silty soil mixed with coarse quartz sands was demonstrated in a laboratory cylindrical tank with diameter of 40 cm and depth of 30 cm. The removal kinetics of semi-volatile n-alkanes (C10, C11, C13-16) under three pulsed heating operations of soil vapor extraction (SVE) was investigated. CMG-STARS software was adopted to simulate the dynamics of heat transfer within the soil column. The results indicated the dramatic increase of air permeability of soil and acceleration of heat transfer after introduction of sand, with the result of achieving rapid soil remediation. Gas-phase transfer of n-alkanes mainly occurred when average soil temperature was ≥100 °C. At the end of remediation with soil subjected to heating for 30.8 h (total running time), the average soil concentration of total n-alkanes was reduced from initial 3106.5 to 202.4 mg/kg, corresponding to 93.4% of mass removal. The residual n-alkanes of C10, C11, C13 and C14 in all collected soil samples were declined to levels of lower than 10 mg/kg. Most of the soil concentration-gradient curves for n-alkanes tested almost coincided with their isothermal contours, indicating the key impact of thermal drive force on contaminant transfer.