Associations of Telemedicine vs. In-Person Ambulatory Care Visits on Cancellation Rates and 30-Day Follow-Up Hospitalizations and Emergency Department Visits

Importance: Studies have shown that telemedicine use in specific conditions can promote continuity of care, decreases healthcare costs, and can potentially improve clinical outcomes. The COVID-19 pandemic forced many healthcare systems to expand access for patients using telemedicine, but little is known about cancellation frequencies in telemedicine vs. in-person appointments and its impact on clinical outcomes. Objective: Compare ambulatory clinic cancellation rates, 30-day inpatient hospitalizations rates, and 30-day emergency department visit rates between in-person and video telemedicine appointments, and examine differences in cancellation rates by age, race/ethnicity, gender, and insurance. Design: A retrospective cohort study. Setting: The largest academic healthcare system in the state of Georgia with ambulatory clinics in urban, suburban and rural settings. Participants: Adults scheduled for an ambulatory clinic appointment from June 2020 to December 2020 were included. Each appointment was identified as either a video telemedicine or in-person clinic appointment. Demographics including age, race, ethnicity, gender, primary insurance, and comorbidities were extracted from the electronic medical record. Main Outcomes and Measures: The primary process outcome was ambulatory clinic cancellation rates. The primary clinical outcomes were 30-day hospitalization rates and 30-day emergency department visit rates. Multivariable logistic regression was used to assess differences in the clinical outcomes between appointment types.

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Abstract P168: Impact of Oral Anticoagulation Choice on Healthcare Utilization for the Primary Treatment of Venous Thromboembolism

Circulation ◽

10.1161/circ.141.suppl_1.p168 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Rob F Walker ◽

Richard F Maclehose ◽

J'Neka Claxton ◽

Terrence Adam ◽

Alvaro Alonso ◽

...

Keyword(s):

Emergency Department ◽

Healthcare Utilization ◽

Oral Anticoagulation ◽

Primary Treatment ◽

Emergency Department Visits ◽

Office Visits ◽

International Classification Of Disease ◽

Hospitalization Rates ◽

The Impact

Introduction: Little is known about the impact of oral anticoagulation (OAC) choice on healthcare encounters during the primary treatment of VTE. Hypothesis: Among anticoagulant-naïve VTE patients we tested the hypotheses that the number of hospitalizations, days hospitalized, emergency department visits, and outpatient office visits would be lower among users of rivaroxaban or apixaban than among users of warfarin. Methods: MarketScan databases for years 2016 and 2017 were used to identify VTE cases and comorbidities using international classification of disease codes, and prescriptions for OACs via outpatient pharmaceutical claims data. Healthcare utilization was identified in the first 6 months after initial VTE diagnoses. Results: The 23,864 individuals with VTE cases were on average (± standard deviation) 55.7 ± 16.1 years old and 50.6% female. Participants had on average 0.2 ± 0.5 hospitalizations, spent 1.3 ± 5.2 days in the hospital, had 5.7 ± 5.1 outpatient encounters, and visited an emergency department 0.4 ± 1.1 times. As compared to warfarin, rivaroxaban and apixaban were associated with fewer hospitalizations, days hospitalized, office visits and emergency department visits, after accounting for age, sex, comorbidities and medications (Table 1). For example, hospitalization rates were 24% lower [IRR: 0.76 (95% CI: 0.69, 0.83)] for patients prescribed rivaroxaban and 22% lower [IRR: 0.78 (95% CI: 0.71, 0.87)] for patients prescribed apixaban, as compared to those prescribed warfarin. When comparing apixaban to rivaroxaban, there were no differences in healthcare utilization. Conclusions: VTE patients prescribed rivaroxaban and apixaban had lower healthcare utilization than did those prescribed warfarin, while there was no difference when comparing apixaban to rivaroxaban. These findings complement existing literature supporting the use of direct OACs over warfarin given their similar effectiveness, slightly better safety profile, and perceived lower patient burden.

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Analysis of Patients with Urolithiasis Visiting the Emergency Department between 2014 and 2016 in Korea: Data from the National Emergency Department Information System

Scientific Reports ◽

10.1038/s41598-019-52950-8 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Jong Wook Kim ◽

Jung-Youn Kim ◽

Sun Tae Ahn ◽

Mi Mi Oh ◽

Du Geon Moon ◽

...

Keyword(s):

Emergency Department ◽

Information System ◽

Early Morning ◽

Emergency Department Visits ◽

Treatment Result ◽

National Database ◽

Annual Percent Change ◽

Hospitalization Rates ◽

Hot Season ◽

National Emergency

Abstract This study investigated the characteristics of patients with urolithiasis visiting an emergency department based on a national database system in Korea. This study spanned a period of three years from January 1, 2014 to December 31, 2016. A retrospective census was conducted using the National Emergency Department Information System for urolithiasis patients. Patient data, including age, sex, insurance type, emergency department visit date and time, discharge date and time, emergency department treatment result, visit flow, and hospitalization route, were extracted and analyzed. Overall, 103,981, 112,083, and 120,647 patients/year during the 2014–2016 study period visited an emergency department with a diagnosis related to urolithiasis. Total monthly emergency department visits ranged from 35,927 in August (highest) to 24,008 in February. Overall, 13.2% of patients were hospitalized and the hospitalization rate was stable (estimated annual percent change) over the study period. Patients aged <9 years or ≥70 years and those with medical aid had higher hospitalization rates. A higher number of visits occurred in the hot season, on weekends, and in the 6 a.m. and 8 p.m. time slots. This nationwide study revealed that the percentage of patients visiting an emergency department with urolithiasis was higher in August, in the early morning, and at weekends.

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The Use of Patient Reported Outcomes to Predict Unplanned Inpatient Hospitalizations and Emergency Department Visits in Cancer Patients Receiving Concurrent Chemotherapy and Radiation Therapy

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/s0360-3016(19)30447-x ◽

2019 ◽

Vol 103 (5) ◽

pp. E20

Author(s):

Amardeep S. Grewal ◽

Peter Gabriel ◽

Abigail Doucette ◽

James M. Metz ◽

Andrzej Wojcieszynski

Keyword(s):

Emergency Department ◽

Radiation Therapy ◽

Cancer Patients ◽

Patient Reported Outcomes ◽

Concurrent Chemotherapy ◽

Emergency Department Visits ◽

Patient Reported ◽

Inpatient Hospitalizations

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Characteristics of psychiatric emergency department use among privately insured adolescents with autism spectrum disorder

Autism ◽

10.1177/1362361317749951 ◽

2018 ◽

Vol 23 (3) ◽

pp. 566-573 ◽

Cited By ~ 4

Author(s):

Luther G Kalb ◽

Elizabeth A Stuart ◽

Roma A Vasa

Keyword(s):

Autism Spectrum Disorder ◽

Emergency Department ◽

Attention Deficit Hyperactivity Disorder ◽

Emergency Department Visit ◽

Attention Deficit ◽

Autism Spectrum ◽

Emergency Department Visits ◽

Spectrum Disorder ◽

Hyperactivity Disorder ◽

Adolescents With Autism

This study examined differences in the rates of psychiatric-related emergency department visits among adolescents with autism spectrum disorder, adolescents with attention deficit hyperactivity disorder, and adolescents without autism spectrum disorder or attention deficit hyperactivity disorder. Additional outcomes included emergency department recidivism, probability of psychiatric hospitalization after the emergency department visit, and receipt of outpatient mental health services before and after the emergency department visit. Data came from privately insured adolescents, aged 12–17 years, with autism spectrum disorder (N = 46,323), attention deficit hyperactivity disorder (N = 408,066), and neither diagnosis (N = 2,330,332), enrolled in the 2010–2013 MarketScan Commercial Claims Database. Adolescents with autism spectrum disorder had an increased rate of psychiatric emergency department visits compared to adolescents with attention deficit hyperactivity disorder (IRR = 2.0, 95% confidence interval: 1.9, 2.1) and adolescents with neither diagnosis (IRR = 9.9, 95% confidence interval: 9.4, 10.4). Compared to the other groups, adolescents with autism spectrum disorder also had an increased probability of emergency department recidivism, psychiatric hospitalization after the emergency department visit, and receipt of outpatient care before and after the visit (all p < 0.001). Further research is required to understand whether these findings extend to youth with other neurodevelopmental disorders, particularly those who are publicly insured.

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Health service inequalities during the COVID-19 pandemic among elderly people living in large urban and non-urban areas in Florida, USA

SAGE Open Medicine ◽

10.1177/2050312120974168 ◽

2020 ◽

Vol 8 ◽

pp. 205031212097416

Author(s):

Xinhua Yu

Keyword(s):

Emergency Department ◽

Elderly People ◽

Rural Areas ◽

Urban Areas ◽

Metropolitan Areas ◽

Elderly Women ◽

Logistic Models ◽

Emergency Department Visits ◽

Hospitalization Rates ◽

Adjusted Incidence

Objective: Health inequalities were often exacerbated during the emerging epidemic. This study examined urban and non-urban inequalities in health services among COVID-19 patients aged 65 years or above in Florida, USA, from 2 March to 27 May 2020. Methods: A retrospective time series analysis was conducted using individual patient records. Multivariable Poisson’s and logistic models were used to calculate adjusted incidence of COVID-19 and the associated rates of emergency department visits, hospitalizations, and deaths. Results: As of 27 May 2020, there were 13,659 elderly COVID-19 patients (people aged 65 years or above) in Florida and 14.9% of them died. Elderly people living in small metropolitan areas might be less likely to be confirmed with COVID-19 infection than those living in large metropolitan areas. The emergency department visit and hospitalization rates decreased significantly across metropolitan statuses for both men and women. Those patients living in small metropolitan or rural areas were less likely to be hospitalized than those living in large metropolitan areas (35% and 34% vs 41%). Elderly women aged 75 years or above living in rural areas had 113% higher adjusted incidence of COVID-19 than those living in large metropolitan areas, and the rates of hospitalizations were lower compared with those counterparts living in large metropolitan areas (29% vs 46%; odds ratio: 0.37 (0.25–0.54), p < 0.001). Conclusion: For elderly people living in Florida, USA, those living in small metropolitan or rural areas were less likely to receive adequate health care than those living in large or medium metropolitan areas during the COVID-19 pandemic.

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