Resource Use Patterns in US Telehealth Services: Machine Learning and Clustering Analysis Across 4 Specialties

Clinical Snapshot

Key Findings

• P Value: P=0.18 for duration difference, P<0.05 for cluster comparisons

• Effect Size: Mean appointment duration reduction of 12.24 minutes for telehealth vs office visits

• Primary Outcome: Telehealth adoption rates varied by specialty: psychiatry 36.9%, behavioral health 23.9%, bariatrics 21.2%, sleep medicine 16.8%

• Nnt Or Sensitivity: Machine learning model R² values: 0.96-0.99 for patient-to-provider ratios, 0.61-0.69 for appointment durations

• Confidence Interval: Not consistently reported

Clinical Application

High feasibility given established telehealth infrastructure and demonstrated sustainability post-pandemic Highly relevant to Australian telehealth expansion under Medicare Benefits Schedule items, particularly for rural and remote access improvement and specialist workforce optimization Outpatient specialty care in psychiatry, behavioral health, bariatrics, and sleep medicine across diverse geographic and demographic settings

Abstract

BACKGROUND: The expansion of telehealth services, particularly during the COVID-19 pandemic, has transformed health care delivery in the United States. Telehealth promises greater access and resource efficiency by reducing wait times and appointment lengths, especially in specialties like psychiatry, behavioral health, bariatrics, and sleep medicine. However, disparities exist in adoption based on demographics, geography, and socioeconomic status, raising concerns about equitable access and optimal resource use. OBJECTIVE: This study aims to evaluate how telehealth impacts health care resource use across 4 specialties by examining 2 key metrics: patient-to-provider ratios and appointment durations. It seeks to understand how factors such as patient demographics, facility characteristics, and social determinants influence telehealth adoption and efficiency using a national dataset spanning from 2018 to 2023. METHODS: We analyzed a deidentified dataset from Epic Cosmos, covering outpatient visits across 48 US states (2018-2023). After data preprocessing and feature engineering, we applied 3 machine learning (ML) models (random forest, extreme gradient boosting, and deep neural networks) to predict resource use. Using the model performing the best, feature importance was assessed using Shapley Additive Explanations values. We then used k-means clustering to group facilities into clusters per specialty. Comparative analyses were conducted to evaluate differences in use among clusters, during and after the pandemic. RESULTS: Telehealth use peaked in 2020 and has remained above prepandemic levels since then. In 2018-2023, telehealth adoption reached 36.9% (4,543,021/12,311,710) in psychiatry, 23.9% (5,321,099/22,264,013) in behavioral health, 21.2% (924,333/4,360,061) in bariatrics, and 16.8% (851,803/5,070,256) in sleep medicine. Telehealth visits were consistently shorter than office visits (mean reduction 12.24 minutes; SD 3.33 minutes; P=.18), while patient-to-provider ratios varied significantly across specialties. Among ML models, extreme gradient boosting regression achieved the best performance (patient-to-provider ratios: R2=0.96-0.99; appointment durations: R2=0.61-0.69). Shapley Additive Explanations analysis identified visit type, telehealth use, facility size, rurality, and Social Vulnerability Index household vulnerability as the strongest predictors. Comparative analyses showed significant differences across clusters (all P<.05). CONCLUSIONS: Telehealth has become a sustainable component of health care, enhancing access and efficiency across both rural and urban areas. However, its impact varies across specialties and regions, highlighting the need for targeted strategies such as staffing support for vulnerable populations, infrastructure investments in rural facilities, and reimbursement models that reflect telehealth's resource use. This study provides robust evidence from ML and clustering analyses, demonstrating how telehealth shapes resource use and offering actionable insights for equitable and sustainable integration.

References

1. 1.Cengil, A. B., Eksioglu, B., Eksioglu, S. D., Hayes, C., Bogulski, C., & Ali, M. (2026). Resource use patterns in US telehealth services: Machine learning and clustering analysis across 4 specialties. JMIR Medical Informatics, 14(1), e78030. https://doi.org/10.2196/78030