Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department.
Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department.
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DOI：
10.1001/jamanetworkopen.2022.37783
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发表时间：
2022-10-03
影响因子：
13.8
通讯作者：
Sarkisian, Catherine A.
中科院分区：
文献类型：
--
作者：
Shah, Vivek V.;Villaflores, Chad W.;Chuong, Linh H.;Leuchter, Richard K.;Kilaru, Austin S.;Vangala, Sitaram;Sarkisian, Catherine A.
在急诊科（艾德）就诊后出院并进行面对面随访的患者与进行远程医疗随访的患者之间，重复住院访视的比率是否存在差异？在这项包括16987次艾德就诊的队列研究中，与亲自随访相比，远程医疗随访与每1000名患者28.3次以上的重复艾德就诊和10.6次以上的再次住院有关。在这项研究中，远程医疗随访访问后，艾德遭遇与较高的重复住院率，即使在控制了表现敏锐度，合并症，和社会人口因素。本队列研究评估了急诊科（艾德）回访率和住院率在接受艾德术后随访护理的面对面与远程医疗接触的患者之间是否存在差异。对于从急诊科（艾德）出院的患者，及时的门诊亲自随访与死亡率的改善相关，但远程医疗作为随访方式的有效性尚不清楚。评价在艾德术后随访护理中获得面对面与远程医疗服务的患者之间，艾德回访率和住院率是否存在差异。这项回顾性队列研究纳入了2020年4月1日至2021年9月30日期间在单一综合城市学术卫生系统的2个系统内ED中的任何一个就诊的成人患者;出院回家;并在其索引艾德访视（共15天）的14天内与初级保健医生进行了随访预约。ED出院后14天内的面对面与远程医疗随访。基于艾德出院后随访的方式，使用多变量logistic回归估计艾德回访（主要结局）或艾德访视后30天内住院（次要结局）的几率。根据年龄、性别、主要语言、人种、种族、社会脆弱性指数、保险类型、到艾德的距离、指数访视的门诊账单代码以及从艾德出院到随访的时间对模型进行了调整。总体而言，12 848例患者共发生16 987例艾德事件（平均[SD]年龄，53 [20]岁; 9714 [57%]例女性; 2009 [12%]例黑人或非裔美国人; 3806 [22%]例西班牙裔或拉丁裔; 9858 [58%]例白色）; 11818人（70%）获得了亲自随访，5169人（30%）获得了远程医疗随访。总体而言，2802例初次艾德就诊（17%）导致返回艾德，676例（4%）导致随后住院。在校正分析中，远程医疗与面对面随访访视相比，与艾德复发率增加（每1000次就诊中艾德复发率增加28.3 [95%CI，11.3-45.3]）和住院率增加（每1000次就诊中住院率增加10.6 [95%CI，2.9-18.3]）相关。在这项城市综合医疗保健系统患者的队列研究中，那些在艾德就诊后接受远程医疗随访的患者比亲自随访的患者更有可能返回艾德并住院。远程医疗的使用值得进一步评价，以检查其有效性作为一种模式，继续照顾后，最初的艾德介绍急性疾病。
Do the rates of repeated hospital visits differ between patients who were discharged following an emergency department (ED) visit and have in-person follow-up visits vs those who have telehealth follow-up visits? In this cohort study that included 16 987 ED visits, telehealth follow-up was associated with 28.3 more repeated ED encounters and 10.6 more return hospital admissions per 1000 patients compared with in-person follow-up. In this study, telehealth follow-up visits after ED encounters were associated with higher rates of repeated hospital visits even after controlling for presentation acuity, comorbidities, and sociodemographic factors. This cohort study evaluates whether the rates of emergency department (ED) return visits and hospitalization differ between patients who obtain in-person vs telehealth encounters for post-ED follow-up care. For patients discharged from the emergency department (ED), timely outpatient in-person follow-up is associated with improved mortality, but the effectiveness of telehealth as follow-up modality is unknown. To evaluate whether the rates of ED return visits and hospitalization differ between patients who obtain in-person vs telehealth encounters for post-ED follow-up care. This retrospective cohort study included adult patients who presented to either of 2 in-system EDs of a single integrated urban academic health system from April 1, 2020, to September 30, 2021; were discharged home; and obtained a follow-up appointment with a primary care physician within 14 days of their index ED visit (15 total days). In-person vs telehealth post–ED discharge follow-up within 14 days. Multivariable logistic regression was used to estimate the odds of ED return visits (primary outcome) or hospitalization (secondary outcome) within 30 days of an ED visit based on the modality of post–ED discharge follow-up. Models were adjusted for age, sex, primary language, race, ethnicity, Social Vulnerability Index, insurance type, distance to the ED, ambulatory billing codes for the index visit, and the time from ED discharge to follow-up. Overall, 12 848 patients with 16 987 ED encounters (mean [SD] age, 53 [20] years; 9714 [57%] women; 2009 [12%] Black or African American; 3806 [22%] Hispanic or Latinx; and 9858 [58%] White) were included; 11 818 (70%) obtained in-person follow-up, and 5169 (30%) obtained telehealth follow-up. Overall, 2802 initial ED encounters (17%) led to returns to the ED, and 676 (4%) led to subsequent hospitalization. In adjusted analyses, telehealth vs in-person follow-up visits were associated with increased rates of ED returns (28.3 [95% CI, 11.3-45.3] more ED returns per 1000 encounters) and hospitalizations (10.6 [95% CI, 2.9-18.3] more hospitalizations per 1000 encounters). In this cohort study of patients in an urban integrated health care system, those with telehealth follow-up visits after an ED encounter were more likely to return to the ED and be hospitalized than patients with in-person follow-up. The use of telehealth warrants further evaluation to examine its effectiveness as a modality for continuing care after an initial ED presentation for acute illness.
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影响因子：
3.6
作者：
McAlearney, Ann Scheck;Gaughan, Alice A.;Shiu-Yee, Karen;DePuccio, Matthew J.
通讯作者：
DePuccio, Matthew J.
在大型商业保险人群中，在Covid-19期间，面对面和远程医疗的遭遇的结果。
影响因子：
13.8
作者：
Hatef, Elham;Lans, Daniel;Bandeian, Stephen;Lasser, Elyse C.;Goldsack, Jennifer;Weiner, Jonathan P.
通讯作者：
Weiner, Jonathan P.
DOI：
10.1016/j.ijnsa.2020.100008
发表时间：
2020-11
影响因子：
--
作者：
Andrews E;Berghofer K;Long J;Prescott A;Caboral-Stevens M
通讯作者：
Caboral-Stevens M
影响因子：
4.4
作者：
Sabbatini, Amber K.;Gallahue, Fiona;Gallagher, Thomas H.
通讯作者：
Gallagher, Thomas H.
影响因子：
3.7
作者：
Stamenova, Vess;Chu, Cherry;Pang, Andrea;Fang, Jiming;Shakeri, Ahmad;Cram, Peter;Bhattacharyya, Onil F.;Bhatia, R. Sacha F.;Tadrous, Mina F.
通讯作者：
Tadrous, Mina F.