Effectiveness of Telemedicine Visits in Reducing 30-Day Readmissions Among Patients With Heart Failure During the COVID-19 Pandemic.
Effectiveness of Telemedicine Visits in Reducing 30-Day Readmissions Among Patients With Heart Failure During the COVID-19 Pandemic.
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DOI：
10.1161/jaha.121.023935
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发表时间：
2022-04-05
影响因子：
5.4
通讯作者：
Dupre, Matthew E.
中科院分区：
文献类型：
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作者：
Xu, Hanzhang;Granger, Bradi B.;Drake, Connor D.;Peterson, Eric D.;Dupre, Matthew E.
COVID-19疫情导致远程医疗迅速应用于临床实践。本研究探讨了通过远程医疗进行的早期门诊随访是否与面对面访视一样有效，以减少心力衰竭患者30天的再入院率。使用来自大型卫生系统的电子健康记录，我们纳入了居住在北卡罗来纳州（N=6918）的心力衰竭患者，这些患者在2020年3月16日至2021年3月14日期间住院。使用加权logistic回归模型检查出院后30天内的全因再入院。总体而言，7.6%（N=526）的患者接受了早期远程医疗随访，38.8%（N=2681）的患者接受了早期现场随访，53.6%（N=3711）的患者在出院后14天内未接受随访。与没有早期随访的患者相比，接受早期随访的患者更年轻，更有可能成为医疗保险受益人，患有更多的合并症，并且不太可能生活在弱势社区。相对于面对面访视，接受远程医疗随访的患者年龄、性别和种族相似，但合并症通常较少。总体而言，30天再入院率（19.0%）在接受远程医疗访视（15.0%）、亲自访视（14.0%）或未随访（23.1%）的患者之间存在差异。协变量调整后，与未随访的患者相比，接受远程医疗（比值比[OR]，0.55; 95% CI，0.44-0.72）或亲自（OR，0.52; 95% CI，0.45-0.60）访视的患者在30天内再次入院的可能性同样较低。在2019冠状病毒病大流行期间，使用远程医疗就诊进行早期随访的情况迅速增加。通过远程医疗或亲自接受门诊随访的心力衰竭患者的结局优于未接受随访的患者。
The COVID‐19 pandemic resulted in a rapid implementation of telemedicine into clinical practice. This study examined whether early outpatient follow‐up via telemedicine is as effective as in‐person visits for reducing 30‐day readmissions in patients with heart failure. Using electronic health records from a large health system, we included patients with heart failure living in North Carolina (N=6918) who were hospitalized between March 16, 2020 and March 14, 2021. All‐cause readmission within 30 days after discharge was examined using weighted logistic regression models. Overall, 7.6% (N=526) of patients received early telemedicine follow‐up, 38.8% (N=2681) received early in‐person follow‐up, and 53.6% (N=3711) did not receive follow‐up within 14 days of discharge. Compared with patients without early follow‐up, those who received early follow‐up were younger, were more likely to be Medicare beneficiaries, had more comorbidities, and were less likely to live in an disadvantaged neighborhood. Relative to in‐person visits, those with telemedicine follow‐up were of similar age, sex, and race but with generally fewer comorbidities. Overall, the 30‐day readmission rate (19.0%) varied among patients who received telemedicine visits (15.0%), in‐person visits (14.0%), or no follow‐up (23.1%). After covariate adjustment, patients who received either telemedicine (odds ratio [OR], 0.55; 95% CI, 0.44–0.72) or in‐person (OR, 0.52; 95% CI, 0.45–0.60) visits were similarly less likely to be readmitted within 30 days compared with patients with no follow‐up. During the COVID‐19 pandemic, the use of telemedicine visits for early follow‐up increased rapidly. Patients with heart failure who received outpatient follow‐up either via telemedicine or in‐person had better outcomes than those who received no follow‐up.