Loyola Marymount University, Los Angeles, CA, United States.
University of South Carolina, Columbia, SC, United States.
J Med Internet Res. 2024 Nov 25;26:e63661. doi: 10.2196/63661.
Geographic, demographic, and socioeconomic differences in health outcomes persist despite the global focus on these issues by health organizations. Barriers to accessing care contribute significantly to these health disparities. Among these barriers, those related to travel time-the time required for patients to travel from their residences to health facilities-remain understudied compared with others.
This study aimed to explore the impact of telehealth in addressing health disparities associated with travel time to hospitals for patients with recurrent hospital admissions. It specifically examined the role of telehealth in reducing in-hospital length of stay (LOS) for patients living farther from the hospital.
We sourced the data from 4 datasets, and our final effective sample consisted of 1,600,699 admissions from 536,182 patients from 63 hospitals in New York and Florida in the United States from 2012 to 2015. We applied fixed-effect models to examine the direct effects and the interaction between telehealth and patients' travel time to hospitals on LOS. We further conducted a series of robustness checks to validate our main models and performed post hoc analyses to explore the different effects of telehealth across various patient groups.
Our summary statistics show that, on average, 22.08% (353,396/1,600,699) of patients were admitted to a hospital with telehealth adopted, with an average LOS of 5.57 (SD 5.06) days and an average travel time of about 16.89 (SD 13.32) minutes. We found that telehealth adoption is associated with a reduced LOS (P<.001) and this effect is especially pronounced as the patients' drive time to the hospital increases. Specifically, the coefficient for drive time is -0.0079 (P<.001), indicating that for every additional minute of driving time, there is a decrease of 0.0079 days (approximately 11 minutes) in the expected LOS. We also found that telehealth adoption has a larger impact on patients frequently needing health services, patients living in high internet coverage areas, and patients who have high virtualization potential diseases.
Our findings suggest that telehealth adoption can mitigate certain health disparities for patients living farther from hospitals. This study provides key insights for health care practitioners and policy makers on telehealth's role in addressing distance-related disparities and planning health care resources. It also has practical implications for hospitals in resource-limited countries that are in the early stages of implementing telehealth.
尽管全球卫生组织关注这些问题，但健康结果在地理、人口和社会经济方面的差异仍然存在。获得医疗服务的障碍是造成这些健康差异的重要原因。在这些障碍中，与旅行时间相关的障碍——患者从居住地到医疗机构所需的时间——与其他障碍相比，研究得还不够充分。
本研究旨在探讨远程医疗在解决因往返医院而导致的健康差异方面的作用，这些差异与反复住院的患者有关。具体来说，本研究考察了远程医疗在减少居住在离医院较远的患者的住院时间（LOS）方面的作用。
我们从 4 个数据集获取数据，最终的有效样本包括 2012 年至 2015 年期间来自美国纽约和佛罗里达州 63 家医院的 536182 名患者的 1600699 例住院记录。我们应用固定效应模型来检验远程医疗与患者前往医院的旅行时间对 LOS 的直接影响以及两者之间的交互作用。我们进一步进行了一系列稳健性检验来验证我们的主要模型，并进行了事后分析来探索远程医疗在不同患者群体中的不同效果。
我们的汇总统计数据显示，平均有 22.08%（353396/1600699）的患者在采用远程医疗的医院接受治疗，平均 LOS 为 5.57（SD 5.06）天，平均旅行时间约为 16.89（SD 13.32）分钟。我们发现，采用远程医疗与 LOS 缩短有关（P<.001），并且这种效果随着患者前往医院的驾驶时间的增加而更加显著。具体而言，驾驶时间的系数为-0.0079（P<.001），这表明每增加 1 分钟的驾驶时间，预计 LOS 就会减少 0.0079 天（约 11 分钟）。我们还发现，远程医疗的采用对经常需要医疗服务的患者、居住在互联网覆盖范围高的地区的患者以及患有高虚拟化潜在疾病的患者有更大的影响。
我们的研究结果表明，远程医疗的采用可以减轻居住在离医院较远的患者的某些健康差异。本研究为医疗保健从业者和政策制定者提供了有关远程医疗在解决与距离相关的差异和规划医疗资源方面的作用的重要见解。它还对处于远程医疗实施早期阶段的资源有限国家的医院具有实际意义。
