Abiri Autherine, Keadey Matthew, Hughes George, Pitts Stephen R, Moran Tim P, Ross Michael A
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA; Nell Hodgson Woodruff School of Nursing, Emory University.
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA.
Ann Emerg Med. 2023 Feb;81(2):222-233. doi: 10.1016/j.annemergmed.2022.07.003. Epub 2022 Oct 15.
STUDY OBJECTIVE(S): We report the impact of telemedicine virtual rounding in emergency department observation units (EDOU) on the effectiveness, safety, and cost relative to traditional observation care.
In this retrospective diff-in-diff study, we compared observation visit outcomes from 2 EDOUs before (pre) and after (post) full adoption of telemedicine rounding tele-observation (tele-obs) with usual care in control EDOU and care in a hospital bed in an integrated health system without tele-obs. Tele-obs physicians did not work at the control hospital. Outcomes were the length of stay, total direct costs, admission status, and adverse events (ICU and death). Difference-in-differences modeling evaluated outcomes with covariates including age, sex, payer type, and clinical classification software diagnostic category. Data from a system data warehouse and a cost accounting database were used.
Of the 20,861 EDOU visits, 15,630 (74.9%) were seen in the preperiod and 6,657 (31.9%) in control EDOU. Of 23,055 non-EDOU inpatient visits assigned to observation status (nonobservation unit), 76% were seen in the preperiod. Adjusted length of stay was not significantly different for tele-obs and control EDOUs (26.4 hours versus 23.5 hours), which remained lower than in hospital settings (37.9 hours). The pre-post diff-in-diff was not significant (P=.78). Inpatient admission status was similar for tele-obs and control EDOUs (20.9% versus 22.4.%) and lower than in hospital settings (30.3%). Prepost odds ratios for inpatient admission and adverse outcomes did not change significantly for all study groups. Adjusted costs increased over time for all settings; however, the prepost median cost change was not significantly different between tele-obs EDOUs and control EDOUs ($162.5 versus $235) and was lower than the change for control hospital settings ($783). Median tele-obs EDOU cost over both periods ($1,541) remained significantly lower than hospital costs ($2,413).
Using tele-obs to manage observation patients in an ED observation unit was not associated with significant differences in length of stay, admission status, measured adverse events, or total direct cost.
我们报告了急诊科观察病房（EDOU）采用远程医疗虚拟查房相对于传统观察护理在有效性、安全性和成本方面的影响。
在这项回顾性双重差分研究中，我们比较了两个EDOU在全面采用远程医疗查房远程观察（远程观察）之前（前）和之后（后）的观察就诊结果，对照组EDOU采用常规护理，而在一个没有远程观察的综合医疗系统中，在医院病床接受护理。远程观察医生不在对照医院工作。结果指标包括住院时间、总直接成本、入院状态和不良事件（入住重症监护病房和死亡）。双重差分模型评估了包括年龄、性别、付款人类型和临床分类软件诊断类别等协变量的结果。使用了系统数据仓库和成本核算数据库中的数据。
在20,861次EDOU就诊中，15,630次（74.9%）发生在前期，6,657次（31.9%）发生在对照EDOU。在分配为观察状态的23,055次非EDOU住院就诊（非观察病房）中，76%发生在前期。远程观察EDOU和对照EDOU的调整后住院时间无显著差异（26.4小时对23.5小时），均低于医院环境（37.9小时）。前后双重差分不显著（P = 0.78）。远程观察EDOU和对照EDOU的住院入院状态相似（20.9%对22.4%），且低于医院环境（30.3%）。所有研究组的住院入院和不良结局的前后比值比均无显著变化。所有环境下的调整成本随时间增加；然而，远程观察EDOU和对照EDOU的前后中位数成本变化无显著差异（162.5美元对235美元），且低于对照医院环境的变化（783美元）。两个时期远程观察EDOU的中位数成本（1,541美元）仍显著低于医院成本（2,413美元）。
在ED观察病房使用远程观察管理观察患者在住院时间、入院状态、测量的不良事件或总直接成本方面无显著差异。
