Examine: Telehealth follow-up linked to return emergency division visits



Sufferers who participated in a telehealth follow-up go to after being handled in an emergency division had been extra more likely to return to the ED and change into hospitalized in contrast with those that had in-person appointments.

The examine, printed this week in JAMA Network Open, analyzed practically 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 major 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 more likely 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 effectively, however the distinction was not statistically important. 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 might have been lacking info that would not be collected in EHRs, like unemployment, revenue or belief within the healthcare system.

Sufferers additionally might have seen a major care doctor outdoors of the well being system studied, whereas Threat Adjustment Issue scores had been usually lacking for uninsured members. Future research must also embrace extra well being techniques, since the deal with one system might restrict the examine’s means to be generalized to different settings. 

Although the examine reveals issues with counting on telehealth for post-discharge care, researchers famous it must be thought-about 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 means 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.

“Additionally it is attainable that unbiased of the dearth of a bodily examination, telehealth clinicians could not have the ability to talk as effectively with sufferers, resulting in an lack of ability to totally consider or intervene on evolving sickness and resulting in deterioration in affected person situation and subsequent want for hospitalization.”

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