Medical Advice Lines Offering On-Demand Access to Providers Reduced Emergency Department Visits

Abstract

Instant access to clinicians through virtual care is designed to allow patients to receive care they need while avoiding high-cost visits in acute care settings. This study investigates the effect of offering patients the option to instantly connect with emergency care providers instead of being referred to the emergency department (ED) following calls to a medical advice line. We employed a staggered rollout design to assess the effects of implementing this program on key outcomes among Veterans Affairs (VA) enrollees. Analyzing over one million calls from 2019 to 2022, we found that access to a provider reduced the proportion of patients who subsequently visited the ED compared to those with access to the standard medical advice line (38% vs. 36%). There was no significant difference observed in subsequent inpatient admissions or 30-day mortality. We found that a majority of callers (65%) achieved issue resolution or were directed to lower acuity settings for further evaluation. Although substantial direct cost savings were not evident, our findings demonstrate that on-demand to a virtual provider can effectively decrease ED visits.