Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusettes, USA.
Department of Emergency Medicine, Harvard Medical School, Boston, Massachusettes, USA.
Telemed J E Health. 2024 Feb;30(2):527-535. doi: 10.1089/tmj.2023.0265. Epub 2023 Jul 31.
Telehealth capacity may be an important component of pandemic response infrastructure. We aimed to examine changes in the telehealth use by the US emergency departments (EDs) during COVID-19, and to determine whether existing telehealth infrastructure or increased system integration were associated with increased likelihood of use. We analyzed 2016-2020 National ED Inventory (NEDI)-USA data, including ED characteristics and nature of telehealth use for all US EDs. American Hospital Association data characterized EDs' system integration. An ordinary least-squares regression model obtained one-step-ahead forecast of the expected proportion of EDs using telehealth in 2020 based on growth observed from 2016 to 2019. Among EDs without telehealth in 2019, we used logistic regression models to examine whether system membership or existing telehealth infrastructure were associated with odds of innovation in telehealth use in 2020, accounting for ED characteristics. Of 4,038 EDs responding to telehealth questions in 2019 and 2020 (73% response rate), 3,015 used telehealth in 2020. Telehealth use by US EDs increased more than expected in 2020 (2016: 58%, 2017: 61%, 2018: 65%, 2019: 67%, 2020: 74%, greater than predicted 71%, p = 0.004). Existing telehealth infrastructure was associated with increased telehealth innovation (OR = 1.88, 95% CI: 1.49-2.36), whereas hospital system membership was not (odds ratio [OR] = 1.00, 95% confidence interval [CI]: 0.80-1.25). Telehealth use by US EDs in 2020 grew more than expected and preexisting telehealth infrastructure was associated with increased innovation in its use. Preparation for future pandemic responses may benefit from considering strategies to invest in local infrastructure to facilitate technology adoption and innovation.
远程医疗能力可能是大流行应对基础设施的一个重要组成部分。我们旨在研究美国急诊部（ED）在 COVID-19 期间远程医疗使用的变化，并确定现有的远程医疗基础设施或系统集成度的增加是否与使用可能性的增加相关。我们分析了 2016-2020 年全国急诊部库存（NEDI）-美国的数据，包括美国所有 ED 的 ED 特征和远程医疗使用的性质。美国医院协会的数据描述了 ED 的系统集成情况。普通最小二乘法回归模型根据 2016 年至 2019 年的增长情况，获得了 2020 年预计使用远程医疗的 ED 比例的一步预测。在 2019 年没有远程医疗的 ED 中，我们使用逻辑回归模型来检验系统成员资格或现有的远程医疗基础设施是否与 2020 年远程医疗使用创新的几率相关，同时考虑 ED 的特征。在 2019 年和 2020 年回复远程医疗问题的 4038 家 ED 中（73%的回复率），有 3015 家在 2020 年使用了远程医疗。美国 ED 的远程医疗使用在 2020 年的增长超过了预期（2016 年：58%，2017 年：61%，2018 年：65%，2019 年：67%，2020 年：74%，比预测值高 71%，p=0.004）。现有的远程医疗基础设施与远程医疗创新的增加有关（比值比[OR]=1.88，95%置信区间[CI]：1.49-2.36），而医院系统成员资格则没有（比值比[OR]=1.00，95%CI：0.80-1.25）。美国 ED 在 2020 年的远程医疗使用增长超过了预期，现有的远程医疗基础设施与远程医疗使用创新的增加有关。为未来的大流行应对做准备可能受益于考虑投资当地基础设施的战略，以促进技术采用和创新。
