Sufferers who participated in a telehealth follow-up go to after being handled in an emergency division had been extra prone to return to the ED and develop into hospitalized in contrast with those that had in-person appointments.
The examine, revealed this week in JAMA Network Open, analyzed almost 17,000 encounters from two EDs in a single educational well being system in Los Angeles between April 2020 and September 2021. To be included, sufferers needed to have a follow-up appointment with a main care doctor inside 14 days of their first ED go to.
Researchers discovered telehealth follow-up was related to 28.3 extra repeated ED visits and 10.6 extra return hospital admissions per 1,000 sufferers in contrast with in-person follow-up care.
For in-person visits, 16% had been adopted by a return ED go to and 4% embrace a hospital admission inside 30 days. Amongst telehealth follow-ups, 18% had been adopted by one other emergency go to and 5% with a hospitalization.
“On this retrospective cohort examine, we discovered that after being discharged from the ED, sufferers with telehealth post-ED discharge follow-up visits had been extra prone to return to the ED, even after adjustment for sociodemographic traits, insurance coverage sort, distance to the ED, severity of sickness on the index go to, the time from ED discharge to follow-up and medical complexity (RAF [Risk Adjustment Factor] scores),” the researchers wrote.
“There have been numerically elevated subsequent hospitalizations as nicely, however the distinction was not statistically vital. The affiliation of telehealth with elevated healthcare utilization warrants additional examine to guage its appropriateness as modality for post-ED follow-up.”
WHY IT MATTERS
The researchers famous there have been some limitations of their evaluation. As an observational examine, there may have been lacking data that would not be collected in EHRs, like unemployment, earnings or belief within the healthcare system.
Sufferers additionally may have seen a main care doctor exterior of the well being system studied, whereas Danger Adjustment Issue scores had been typically lacking for uninsured contributors. Future research must also embrace extra well being programs, since the give attention to one system may restrict the examine’s skill to be generalized to different settings.
Although the examine exhibits issues with counting on telehealth for post-discharge care, researchers famous it must be thought of in context of telemedicine’s advantages, like managing power circumstances.
“A possible mechanism to elucidate elevated healthcare utilization after telehealth visits is the inherent limitation within the skill of clinicians to look at sufferers, which can compel clinicians to have a decrease threshold for referring sufferers again to the ED for an in-person analysis if they’ve any ongoing signs,” the examine’s authors wrote.
“It’s also doable that unbiased of the shortage of a bodily examination, telehealth clinicians might not be capable to talk as nicely with sufferers, resulting in an incapability to totally consider or intervene on evolving sickness and resulting in deterioration in affected person situation and subsequent want for hospitalization.”
