Telehealth follow-up associated with increased returns and hospitalizations after emergency department visit

Telehealth follow-up consultations following an emergency division go to had been related to 28 extra repeat ED encounters and practically 11 extra return hospital admissions per 1000 sufferers in contrast with in-person follow-ups, UCLA analysis suggests.

The findings, to be revealed within the peer-reviewed JAMA Community Open, held true even when the researchers managed for the seriousness of sufferers’ circumstances, co-morbidities, and sociodemographic components.

One of many first research to hyperlink telemedicine with these detrimental outcomes, these findings come out simply when policymakers and payors are in lively discussions about whether or not and in what conditions telemedicine ought to proceed to be reimbursed.

Although displaying a soar in emergency division returns and hospitalizations after telemedicine consultations, the findings aren’t any cause to utterly abandon using telehealth for well being care follow-ups, mentioned Dr. Vivek Shah, resident doctor within the division of emergency drugs at Harbor-UCLA Medical Middle and the examine’s lead creator.

“It is simply that within the present context, telehealth might not be acceptable for all ED follow-up care,” mentioned Shah, who carried out the analysis as a pupil on the David Geffen College of Drugs at UCLA. “Different teams have proven the advantages of telehealth in particular eventualities with clear care plans, similar to continual obstructive pulmonary illness, coronary heart failure, or diabetes administration. However the situation of an ED follow-up is totally different in that sufferers could also be seen for a myriad of acute circumstances, moderately than continual circumstances that their major care doctor is aware of effectively or has been managing for a few years.”

Usually, most sufferers are anticipated to have an in-person follow-up with their major care doctor about one to 2 weeks after an emergency division go to, Shah mentioned. Within the wake of the COVID pandemic, nonetheless, these consultations started to be held largely through cellphone or video and finally rose to about 30% of all ED follow-up appointments.

The researchers examined information from April 1, 2020 to Sept. 30, 2021 at two UCLA Well being hospital emergency departments. They evaluated 12,848 sufferers with 16,987 emergency division encounters—the distinction in numbers is because of some sufferers having been seen greater than as soon as. Of these encounters, 11,818 led to in-person follow-ups and 5,169 had been by telehealth.

They discovered that general, 2,802 (16.49%) of the preliminary emergency division encounters led to returns to the division and 676 (about 3.8%) led to hospitalizations inside 30 days. Breaking it down by in-person versus telehealth follow-up consultations, they discovered that 1,865 (16%) of in-person follow-ups led to emergency division return visits and 438 (3.7%) resulted in hospitalizations. For telehealth post-discharge follow-ups these numbers had been 938 (18%) and 238 (4.6%), respectively.

To handle this, UCLA researchers have urged one doable method is perhaps a telehealth triage system that takes into consideration affected person complaints to find out which can or might not be acceptable for a telehealth analysis, Shah mentioned.

The researchers word some limitations to their outcomes. These embrace the potential of some unmeasured components that will have influenced who acquired in-person and who had been consulted through telehealth. Additionally, some information had been lacking from uninsured populations, and the examine was carried out solely at UCLA Well being medical facilities, so the outcomes could not apply in different settings.

The researchers conclude, nonetheless, that their findings point out that the “affiliation of telehealth with elevated healthcare utilization warrants additional examine to judge its appropriateness as modality for post-ED follow-up.”

Research co-authors are Chad Villaflores, Linh Chuong, Dr. Richard Leuchter, Sitaram Vangala, and Dr. Catherine Sarkisian of UCLA, and Dr. Austin Kilaru of the College of Pennsylvania.