Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa.
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland.
J Rural Health. 2020 Jun;36(3):360-370. doi: 10.1111/jrh.12370. Epub 2019 Apr 23.
To study the relationship between the availability and activation of emergency department-based telemedicine (teleED) and patient disposition in Critical Access Hospitals (CAHs).
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.
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.
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.
研究基于急诊科的远程医疗（远程医疗）的可用性和激活与关键通道医院（CAH）患者处置之间的关系。
一项非随机阶梯楔形设计检查了订阅单一远程医疗提供商的 15 家 CAH 中的 133396 例 ED 就诊。在远程医疗实施之前至少有 12 个月的数据，并且在实施之后至少有 12 个月的数据。主要分析使用多项逻辑回归模型，使用远程 ED 可用性（后远程 ED 实施期间的指标）和激活（远程医疗服务利用的指标）来预测调整年龄，性别和临床诊断后的出院处置。
远程 ED 被激活的患者更有可能转移[调整后的优势比（aOR）= 12.04; 95％置信区间（CI），10.97-13.21]，更有可能被转至当地医院（aOR = 3.23; 95％CI，2.84-3.67），而不是常规出院。对于胸痛，精神疾病和伤害/中毒的患者，这种模式得到了证实。但是，在远程医疗实施后的时期，在远程医疗可用但不一定使用的情况下，到 ED 就诊的患者更不可能被当地医院收治（aOR = 0.79; 95％CI，0.76-0.82），而常规出院的可能性更高。
CAH ED 中远程医疗的可用性与 ED 常规出院的可能性更高相关，这可能是由于与远程医疗实施相关的护理变化所致。远程 ED 使用与处置之间的关系可能与为更可能需要住院治疗的病例激活远程 ED 的选择有关。
