Journal article
Provider-to-provider telehealth for sepsis patients in a cohort of rural emergency departments
Academic emergency medicine, Vol.31(4), pp.326-338
04/2024
DOI: 10.1111/acem.14857
PMID: 38112033
Abstract
Telehealth has been proposed as one strategy to improve the quality of time-sensitive sepsis care in rural emergency departments (EDs). The purpose of this study was to measure the association between telehealth-supplemented ED (tele-ED) care, healthcare costs, and clinical outcomes among patients with sepsis in rural EDs.
Cohort study using Medicare fee-for-service claims data for beneficiaries treated for sepsis in rural EDs between February 1, 2017 and September 30, 2019. Our primary hospital-level analysis used multivariable generalized estimating equations (GEE) to measure the association between treatment in a tele-ED-capable hospital and 30-day total costs of care. In our supporting secondary analysis, we conducted a propensity-matched analysis of patients who used tele-ED with matched controls from non-tele-ED-capable hospitals. Our primary outcome was total healthcare payments among index hospitalized patients between the index ED visit and 30 days after hospital discharge, and our secondary outcomes included hospital mortality, hospital length-of-stay, 90-day mortality, 28-day hospital-free-days, and 30-day inpatient readmissions.
In our primary analysis, sepsis patients in tele-ED-capable hospitals had 6.7% higher (95% CI 2.1 to 11.5%) total healthcare costs compared to those in non-tele-ED-capable hospitals. In our propensity-matched patient-level analysis, total healthcare costs were 23% higher (95% CI 16.5 to 30.4%) in tele-ED cases than matched non-tele-ED controls. Clinical outcomes were similar.
Tele-ED capability in a mature rural tele-ED network was not associated with decreased healthcare costs or improved clinical outcomes. Future work is needed to reduce rural-urban sepsis care disparities and formalize systems of regionalized care.
Details
- Title: Subtitle
- Provider-to-provider telehealth for sepsis patients in a cohort of rural emergency departments
- Creators
- Nicholas M Mohr - Departments of Emergency Medicine, Anesthesia, and Epidemiology, University of Iowa Carver College of Medicine, Iowa City, IowaTracy Young - University of IowaJ Priyanka Vakkalanka - Departments of Emergency Medicine, and Epidemiology, University of Iowa Carver College of Medicine, Iowa City, IowaKnute D Carter - University of IowaDan M Shane - University of IowaFred Ullrich - University of IowaAllison R Schuette - University of UtahLuke J Mack - University of South DakotaKatie DeJong - Avel eCARE, Sioux Falls, South DakotaAmanda Bell - Avel eCARE, Sioux Falls, South DakotaMark Pals - Avel eCARE, Sioux Falls, South DakotaCarlos A Camargo Jr - Massachusetts General HospitalKori S Zachrison - Massachusetts General HospitalKrislyn M Boggs - Massachusetts General HospitalAdam Skibbe - University of IowaMarcia M Ward - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Academic emergency medicine, Vol.31(4), pp.326-338
- DOI
- 10.1111/acem.14857
- PMID
- 38112033
- NLM abbreviation
- Acad Emerg Med
- eISSN
- 1553-2712
- Grant note
- DOI: 10.13039/100000102, name: Health Resources and Services Administration, award: U3GRH40003; DOI: 10.13039/100000133, name: Agency for Healthcare Research and Quality, award: K08HS025753
- Language
- English
- Electronic publication date
- 12/19/2023
- Date published
- 04/2024
- Academic Unit
- Rural Telehealth Research Center; Occupational and Environmental Health; Health Management and Policy; Epidemiology; Economics; Emergency Medicine; Biostatistics; Anesthesia; Injury Prevention Research Center; Public Policy Center (Archive)
- Record Identifier
- 9984531522502771
Metrics
31 Record Views