An Evaluation of Virtual Care for Gestational Diabetes using the Quadruple Aim Framework: Assessment of Patient and Provider Experience, Cost and Clinical Outcomes

Background and Aims: The objective of this study was to evaluate the impact of virtual care for gestational diabetes (GDM) in the context of the COVID-19 pandemic. Methods: This mixed methods program evaluation used the quadruple aim framework. The impact on patient and provider satisfaction and costs was assessed with surveys and interviews. Chi-square tests of independence compared clinical outcomes before (April 2019-Feb 2020) to after (May 2020-March 2021) the shift to virtual care. Results: 82 women completed a patient experience questionnaire. The majority rated their virtual care experience as good or excellent (93%) with a preference to continue visits in the future (84%). Most respondents felt virtual care saved them money (90%) and time (98%). Providers all felt the switch to virtual care was positive but there was concern about the loss of non-verbal cues and personal connections. Physicians noted increased efficiency however more difficulty with assessing glucose trends. Nurses noted an increased work load, concerns about adequacy of patient education and delays in insulin initiation. When comparing outcomes for women who received in-person and virtual care there were no significant difference in rates of insulin initiation, C-sections, macrosomia or NICU admissions. There was a decreased rate of missed appointments after the switch to virtual care (6.1% vs 1.1%, p-value < .01). Conclusions: There has been high patient and provider satisfaction for virtual GDM care with no difference in clinical outcomes and less missed appointments. Virtual GDM care should remain an option in the future.