Comparing audiovisual visit and in-person visit note quality

BACKGROUND: The pandemic dramatically increased in the frequency of audiovisual medical visits and the rate of audiovisual visits remains higher than before the pandemic. These visits have the potential to be an important clinical modality. Researchers have assessed several aspects of audiovisual visits but they have not investigated their clinical note quality. The goal of this study is to determine the quality of audiovisual and in-person clinical notes and to compare their quality.

METHODS: From a population of 1660 established outpatient primary care type 2 diabetic patient visits occurring in 2021 we randomly selected 100 audiovisual and 100 in-person visits. QNOTE, a validated instrument that measures clinical note quality, was used by 7 experienced primary care physicians to assess 4 key elements of the clinical note: the chief complaint, history of present illness, assessment, and plan.

RESULTS: The mean quality scores (out of 100) and their standard deviations (SD) were: overall, audiovisual 75.8 (SD 9.6), in-person 86.5 (SD 4.4), P  < .0001; chief complaint, audiovisual 72.4 (SD 23.0), in-person 83.0 (SD 14.7), P  < .0001; history of present illness, audiovisual 63.7 (SD 22.9), in-person 82.5 (SD, 15.8), P  < .0001; assessment, audiovisual 82.9 (SD 14.8), in-person 89.8 (SD 10.0), P  = .0002; and plan, audiovisual 84.1 (SD 13.7), in-person 90.9 (SD 8.7), P  < .0001. The in-person scores are consistent with a previous QNOTE study. The rater intraclass correlation coefficient was excellent (0.81, 95% CI, 0.76-0.86).

CONCLUSION: Audiovisual visits demonstrated a lower note quality than in-person visits. To our knowledge, this is the first study to assess the quality of audiovisual visit notes and compare them to the quality of in-person visit notes.