Research

Despite the widespread introduction of virtual visits within ambulatory care, the impact of this new care mode on the adopting patients remains underexplored. This study conducts a comprehensive long-term evaluation of patients’ uptake of virtual visits across a wide range of medical specialties within the ambulatory care setting, exploring the effect of virtual visit adoption on adopters’ utilization of ambulatory care and health outcomes. Moreover, considering the existing health disparities in the United States, we explore whether the effects of virtual visit adoption vary with respect to a patient’s race, socioeconomic status, and gender. 

To study our research questions, we assembled a unique patient panel dataset from a major health system in the Midwest of the United States that includes 1,691,617 encounters by 15,690 patients between January 1, 2018 and December 31, 2022. Our findings indicate that patients who adopt virtual visits tend to conduct fewer in-person appointments, maintaining a similar number of visits in total, which suggests that virtual visits replace some office visits. Notably, adopters also experience fewer emergency room visits and hospitalizations, indicating an improvement in their health and the efficiency of ambulatory care clinics. We, however, also observe an increased volume of portal messages among the adopters, signaling a potential rise in the overall ambulatory care utilization. Importantly, our results reveal significant effect heterogeneity: some underserved populations appear to benefit disproportionately from virtual visit adoption, which indicates the potential of virtual visits to reduce existing access and health disparities in the United States. 

This study highlights the strategic value of virtual visits in enhancing the efficiency of ambulatory care systems. It provides insights into which patient groups might benefit the most from conducting virtual visits and suggests design strategies for health services to optimize their operational impact. Theoretically, this research enriches the Healthcare Operations Management literature in telemedicine by offering a deeper understanding of the long-term effects of virtual visit adoption on a broad patient population.

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Building on the first study, which found positive effects of virtual visits on patient outcomes and healthcare delivery efficiency in ambulatory care clinics, the second essay evaluates the mechanisms behind these positive impacts. Specifically, we explore whether regularity and continuity of care are some of the mechanisms. Regularity of care concerns the timing of care seeking, specifically how dispersed visits are over time, while continuity of care evaluates whether the patient consistently sees the same provider. Our findings indicate that increased virtual visit utilization is associated with better regularity and continuity of care. Additionally, we find that both factors – care regularity and continuity – partially mediate the positive relationship between virtual visit use and patient health outcomes, with continuity of care having a stronger impact. That confirms that regular care seeking behavior and consistently seeing the same provider are key mechanisms through which virtual visits help patients better manage their health within the ambulatory clinic setting. Health outcomes in this study are measured by patients' blood pressure readings (both systolic and diastolic), the number of emergency room visits, outpatient procedures, and total charges. Specifically, we find that an increase in virtual visit use is associated with a decrease in systolic blood pressure, the number of outpatient procedures and emergency room visits, as well as total charges. 

My third essay examines virtual visit adoption from the physicians’ perspective. Specifically, we seek to understand whether providers who start utilizing virtual visits experience changes in workload and well-being, given that the first study revealed an increase in the portal message volume exchanged between patients who adopt virtual visits and their providers. In particular, we investigate whether the use of virtual visits is associated with changes in the amount of time providers spend working during "pajama time" (non-business hours) and their likelihood of quitting the practice.