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Study Finds Telehealth May Not Be Best for ED Follow-Up Care

Analysis  |  By Eric Wicklund  
   October 28, 2022

According to researchers at UCLA, patients using telehealth for follow-up care after ED discharge were more likely to return to the hospital and be admitted than those who followed up an ED visit with an in-person visit.

New research finds that telehealth isn't always better than in-person care, and it can sometimes lead to more healthcare visits and even hospitalization.

A study led by researchers at UCLA and published in the Journal of the American Medical Association (JAMA) compared follow-up care for patients who'd visited the Emergency Department at the California health system between April of 2020 and September 2021, and found that patients using telehealth were more apt to seek in-person care and be rehospitalized than those who'd had in-person care.

The study analyzed almost 17,000 ED encounters from roughly 13,000 patients at two hospitals, and found that 16% of those who'd had in-person post-discharge follow-up visits returned to the ED and 4% were rehospitalized within 30 days, while 18% of those using telehealth for a follow-up visit returned to the ED and 5% were rehospitalized.

The study isn't necessarily earth-shattering, in that telehealth advocates have stressed that virtual care doesn't replace in-person care and isn't appropriate for all services. But it does highlight the need to compare the two treatment modes and study when and where telehealth is appropriate.

"While telemedicine has been heralded for its potential to improve health care access and convenience, the findings of the study … highlight the need to better understand the limitations of this care modality," Charlie Wray, DO, MS, of the University of California, San Francisco and San Francisco VA Medical Center, said in an accompanying editorial. "Like any other medical intervention, telemedicine can have unintended consequences that eclipse its benefits. Some of these limitations include diminished patient-clinician relationships, decreased efficiency of health care delivery, and lower quality of care."

The study was led by Vivek Shah, MD, of Harbor-UCLA Medical Center, and colleagues from UCLA's David Geffen School of Medicine and Fielding School of Public Health, and the University of Pennsylvania's Perelman School of Medicine and Leonard Davis School for Health Economics.

Shah and his colleagues noted that telehealth studies have seen good results in the treatment of people living with chronic conditions, while the results are mixed in the use of virtual care in acute care settings.

"A potential mechanism to explain increased healthcare utilization after telehealth visits is the inherent limitation in the ability of clinicians to examine patients, which may compel clinicians to have a lower threshold for referring patients back to the ED for an in-person evaluation if they have any ongoing symptoms," the study noted. "It is also possible that independent of the lack of a physical examination, telehealth clinicians may not be able to communicate as well with patients, leading to an inability to fully evaluate or intervene on evolving illness and leading to deterioration in patient condition and subsequent need for hospitalization."

It's also worth noting that ED visits that require follow-up care tend to involve more acute concerns, such as chest pain, abdominal pain, and shortness of breath—all of which could be serious and would need an in-person exam.

This doesn't mean the use of telehealth in the ED is a complete waste of time or money, either. Health systems have seen success using the platform to screen and even treat patients with less-acute health concerns, thus enabling ED staff to more quickly treat those who need in-person care.

The conclusion here is that health systems have to understand the benefits and limitations of telehealth in different departments and for different patient populations, so as to know when it will work and when in-person care is required.

Eric Wicklund is the Innovation and Technology Editor for HealthLeaders.


KEY TAKEAWAYS

A study of ED follow-up visits at two Los Angeles hospitals in 2020 and 2021 found that patients using telehealth for follow-up care were more likely than those following up in-person to return to the hospital and be re-admitted within 30 days.

Researchers say that's because patients receiving ED care are more likely to have acute concerns, such as chest pain, abdominal pain and shortness of breath, that need in-person treatment.

The study doesn't mean telehealth is a waste of time and money in the ED, as it can be used to screen and treat less-acute cases, but it does put the emphasis on understanding when and where telehealth can be used in the hospital setting.


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