PMID- 31013552
OWN - NLM
STAT- MEDLINE
DCOM- 20210809
LR  - 20210809
IS  - 1748-0361 (Electronic)
IS  - 0890-765X (Linking)
VI  - 36
IP  - 3
DP  - 2020 Jun
TI  - The Association Between Telemedicine and Emergency Department (ED) Disposition: A 
      Stepped Wedge Design of an ED-Based Telemedicine Program in Critical Access 
      Hospitals.
PG  - 360-370
LID - 10.1111/jrh.12370 [doi]
AB  - PURPOSE: To study the relationship between the availability and activation of 
      emergency department-based telemedicine (teleED) and patient disposition in 
      Critical Access Hospitals (CAHs). METHODS: A non randomized stepped wedge design 
      examined 133,396 ED visits in 15 CAHs that subscribe to a single teleED provider. 
      Data were available for at least 12 months prior to teleED implementation and at 
      least 12 months of post-implementation. Primary analyses were conducted using 
      multinomial logistic regression models with teleED availability (indicator of 
      post-teleED implementation period) and activation (indicator of utilization of 
      teleED service) predicting discharge disposition adjusting for age, sex, and 
      clinical diagnosis. RESULTS: Patients for whom teleED was activated were more 
      likely to be transferred [adjusted odds ratio (aOR) = 12.04; 95% confidence 
      interval (CI), 10.97-13.21] and more likely to be admitted to the local hospital 
      (aOR = 3.23; 95% CI, 2.84-3.67) than to be routinely discharged. This pattern was 
      confirmed for patients presenting with chest pain, mental illness, and 
      injury/poisoning. However, in the period following teleED implementation, 
      patients presenting to EDs after telemedicine was available, but not necessarily 
      utilized, were less likely to be admitted to the local hospital (aOR = 0.79; 95% 
      CI, 0.76-0.82) than to be routinely discharged. CONCLUSIONS: Telemedicine 
      availability in CAH EDs is associated with a higher likelihood of routine 
      discharges from the ED possibly due to changes in care associated with teleED 
      implementation. The relationship between teleED use and disposition may be 
      related to selection in activating teleED for cases more likely to require 
      hospital inpatient care.
CI  - (c) 2019 National Rural Health Association.
FAU - Natafgi, Nabil
AU  - Natafgi N
AD  - Department of Health Management and Policy, University of Iowa College of Public 
      Health, Iowa City, Iowa.
AD  - Department of Pharmaceutical Health Services Research, University of Maryland 
      School of Pharmacy, Baltimore, Maryland.
FAU - Mohr, Nicholas M
AU  - Mohr NM
AUID- ORCID: 0000-0003-0497-5828
AD  - Department of Emergency Medicine, University of Iowa Carver College of Medicine, 
      Iowa City, Iowa.
FAU - Wittrock, Amy
AU  - Wittrock A
AD  - Avera eCARE, Sioux Falls, South Dakota.
FAU - Bell, Amanda
AU  - Bell A
AD  - Avera eCARE, Sioux Falls, South Dakota.
FAU - Ward, Marcia M
AU  - Ward MM
AD  - Department of Health Management and Policy, University of Iowa College of Public 
      Health, Iowa City, Iowa.
LA  - eng
GR  - U1C RH29074/Rural Telehealth Research Center/International
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
DEP - 20190423
PL  - England
TA  - J Rural Health
JT  - The Journal of rural health : official journal of the American Rural Health 
      Association and the National Rural Health Care Association
JID - 8508122
SB  - IM
MH  - *Emergency Service, Hospital
MH  - Hospitalization
MH  - Hospitals
MH  - Humans
MH  - *Patient Transfer
MH  - Retrospective Studies
MH  - *Telemedicine
OTO - NOTNLM
OT  - critical access hospital (CAH)
OT  - emergency service
OT  - patient discharge
OT  - telehealth
OT  - telemedicine
EDAT- 2019/04/24 06:00
MHDA- 2021/08/10 06:00
CRDT- 2019/04/24 06:00
PHST- 2018/08/06 00:00 [received]
PHST- 2019/02/17 00:00 [revised]
PHST- 2019/03/11 00:00 [accepted]
PHST- 2019/04/24 06:00 [pubmed]
PHST- 2021/08/10 06:00 [medline]
PHST- 2019/04/24 06:00 [entrez]
AID - 10.1111/jrh.12370 [doi]
PST - ppublish
SO  - J Rural Health. 2020 Jun;36(3):360-370. doi: 10.1111/jrh.12370. Epub 2019 Apr 23.