Telemedicine is associated with rapid transfer and fewer involuntary holds among patients presenting with suicidal ideation in rural hospitals: a propensity matched cohort study.
Jayamalathi Priyanka Vakkalanka, Karisa K Harland, Amy Wittrock, Margaret Schmidt, Luke Mack, Matthew Nipe, Elaine Himadi, Marcia M Ward, Nicholas M Mohr
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引用次数: 0
Abstract
Objective: The purpose of this study was to evaluate the impact of telemedicine in clinical management and patient outcomes of patients presenting to rural critical access hospital emergency departments (EDs) with suicidal ideation or attempt.
Methods: Retrospective propensity-matched cohort study of patients treated for suicidal attempt and ideation in 13 rural critical access hospital EDs participating in a telemedicine network. Patients for whom telemedicine was used were matched 1:1 to those who did not have telemedicine as an exposure (n=139 TM+, n=139 TM-) using optimal matching of propensity scores based on administrative data. Our primary outcome was ED length-of-stay (LOS), and secondary outcomes included admission proportion, use of chemical or physical restraint, 30 day ED return, involuntary detention orders, treatment/follow-up plan and 6-month mortality. Analyses for multivariable models were conducted using conditional linear and logistic regression clustered on matched pairs with purposeful selection of covariates.
Results: Mean ED LOS was not associated with telemedicine consultation among all patients, but was associated with a 29.3% decrease in transferred patients (95% CI 11.1 to 47.5). The adjusted odds of hospital admission (either local or through transfer) was 2.35 (95% CI 1.10 to 5.00) times greater among TM+ patients compared with TM- patients. Involuntary hold placement was lower in those exposed to telemedicine (adjusted odds ratio (aOR): 0.48; 95% CI 0.23 to 0.97). We did not observe significant differences in other outcomes.
Conclusion: The role of telemedicine in influencing access, quality and efficiency of care in underserved rural hospitals is critically important as these networks become more prevalent in rural healthcare environments.
研究目的本研究旨在评估远程医疗对农村危急重症医院急诊科(ED)中有自杀意念或企图自杀的患者的临床管理和患者预后的影响:方法:对参与远程医疗网络的 13 家农村危急重症医院急诊科的自杀未遂和意念患者进行倾向匹配队列回顾性研究。使用基于管理数据的倾向评分进行优化匹配,将使用远程医疗的患者与未使用远程医疗的患者(n=139 TM+,n=139 TM-)进行 1:1 匹配。我们的主要结果是急诊室停留时间(LOS),次要结果包括入院比例、使用化学或物理约束、30 天急诊室返院率、非自愿拘留令、治疗/随访计划和 6 个月死亡率。多变量模型的分析采用条件线性回归和逻辑回归的方法,对匹配对进行聚类,并有目的地选择协变量:结果:所有患者的平均 ED LOS 与远程医疗咨询无关,但转院患者的平均 ED LOS 缩短了 29.3%(95% CI 11.1 至 47.5)。与远程医疗患者相比,远程医疗+患者入院(本地或转院)的调整后几率是远程医疗-患者的 2.35 倍(95% CI 1.10 至 5.00)。接受远程医疗的患者非自愿留院的比例较低(调整后的几率比(aOR):0.48;95% CI 0.23 至 0.97)。我们没有观察到其他结果有明显差异:结论:随着远程医疗网络在农村医疗环境中的日益普及,远程医疗在影响医疗服务不足的农村医院的医疗服务获取、质量和效率方面的作用至关重要。