Annals of emergency medicine最新文献

Study objective: To describe the use of telemedicine for outpatient follow-up care after discharge from the emergency department (ED) in a large cohort of patients with commercial insurance or Medicare Advantage and determine whether telemedicine follow-up was associated with greater return hospitalizations compared with in-person care.

Methods: Using administrative claims data, we conducted a retrospective cohort study of adults discharged from the ED with congestive heart failure, diabetes, chronic obstructive pulmonary disease, or asthma, from 2020 to 2022. The primary outcome was modality of the first outpatient visit within 14 days, either in person or via telemedicine. We used multivariable logistic regression to examine patient characteristics associated with use of telemedicine compared with in-person follow-up. We also used time-to-event methods to estimate the risk of return hospitalization for patients who obtained telemedicine versus in-person follow-up.

Results: Among 147,561 patients discharged from the ED (mean age 63.9 years; 56.5% women), we found that 4,107 (2.8%) obtained telemedicine follow-up visits and 34,882 (23.6%) obtained in-person follow-up. An additional 7,487 (5.1%) patients were hospitalized prior to obtaining any follow-up. Use of telemedicine varied across conditions and was associated with younger age, female sex, more comorbidities, and ED visit complexity. Telemedicine was not associated with greater risk of return hospitalization compared with in-persnon follow-up.

Conclusion: ED patients used telemedicine for outpatient follow-up visits at low rates, with comparable rates of return hospitalization to those who obtained in-person follow-up. Future studies may examine focused interventions to deploy telemedicine to expand access to follow-up care for selected patients.

Study objective: Frequent past-year emergency department (ED) use is a risk factor for suicide but also presents an intervention opportunity. This study aimed to quantify ED visit timing among suicide decedents by past-year ED use and characterize differences between suicide decedents and other ED patient populations.

Methods: ED records were obtained from the North Carolina Disease Event Tracking and Epidemiological Collection Tool (NC DETECT), and death records were obtained from the NC Violent Death Reporting System (NC-VDRS). ED visits corresponding to the decedent's suicide were probabilistically linked to their corresponding death record. Decedents were classified as frequent (≥4) and infrequent (<4) users based on nonfatal ED visits occurring within one year of their death. Timing from decedents' final nonfatal visit to death was assessed. Decedents' demographics and visit characteristics were compared with all ED patients and mental health patients, stratified by past-year use.

Results: From 2019 to 2020, 670 of 2,883 NC-VDRS suicide decedents linked to an ED visit associated with their suicide. One third (n=213) of linked decedents had past-year ED use. Among these individuals, 21.6% (n=46) were frequent users. Within 30 days of their final nonfatal visit, only 28% of frequent users survived, compared with 65% of infrequent users (difference: -36.4% [-51.3% to -21.5%]). Suicide decedents with frequent use were distinct from infrequent users and from both reference groups regarding demographic and visit-level characteristics.

Conclusion: Suicide decedents who visited the ED once or who were frequent users were demographically distinct from the overall population of ED patients. Timing from final nonfatal ED visit to death by suicide varied with past-year use.