Estimating the Proportion of Telehealth-Able United States Emergency Department Visits - 15/01/25

Doi : 10.1016/j.annemergmed.2024.12.003

K. Noelle Tune, MD ^a, Kori S. Zachrison, MD, MSc ^a, Jesse M. Pines, MD, MBA ^b,^c, Hui Zheng, PhD ^d, Emily M. Hayden, MD, MHPE ^a,^⁎
^a Department of Emergency Medicine Massachusetts General Hospital, Boston, MA
^b Clinical Innovations, US Acute Care Solutions, Canton, OH
^c Department of Emergency Medicine, George Washington University, Washington DC
^d Biostatistics Center, Massachusetts General Hospital, Boston, MA

^∗Corresponding Author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 15 January 2025

Abstract

Study objective

We use national emergency department (ED) data to identify the proportion of “telehealth-able” ED visits, defined as potentially conductible by Video Only or Video Plus (with limited outpatient testing).

Methods

We used ED visits by patients 4 years of age and older from the 2019 National Hospital Ambulatory Medical Care Survey and applied survey weighting for national representativeness. Two raters categorized patient-described Reasons for Visit (RFV) as telehealth-able (yes, no, uncertain) for both Video Only and Video Plus visits. This categorization was stratified by age (4 to 17 years old, 18 to 35, 36 to 64, and 65 and older). Visit characteristics that were used to remove further nontelehealth-able visits included admission, procedures, diagnostic testing, acuity level, and pain score.

Results

Our sample included 133.6 million United States ED visits in 2019 for patients aged 4 years or older. Of those, between 3.4% and 8.8% of visits were telehealth-able by Video Only and between 5.0% and 9.7% by Video Plus, considering only the first RFV. Visits by younger patients were more often telehealth-able, with the proportion of telehealth-able visits decreasing with advancing age. Considering all RFVs, between 0% to 6.6% of ED visits were telehealth-able with Video Only and 0.02% to 7.6% with Video Plus.

Conclusion

Between 3% and 10% of United States ED visits may be potentially telehealth-able for patients aged 4 years and older, considering the first listed RFV and ED visit characteristics. Fewer visits may be telehealth-able when all reasons for visits are considered.

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Keywords : Telehealth, Virtual visits, Crowding, NHAMCS

Plan

Introduction

Background

Importance

Goals of This Investigation

Materials and Methods

Study Design

Study Setting, Data Source, Population

	Please see page XX for the Editor’s Capsule Summary of this article.
	Supervising editor: Stephen Schenkel, MD, MPP. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: EMH, KSZ, JMP, and KNT: study concept and design; EMH, KSZ, JMP, and KNT: analysis and interpretation of the data; EMH, KSZ, JMP, and KNT: drafting of the manuscript; EMH, KSZ, JMP, and KNT critical revision of the manuscript for important intellectual content; HZ and KSZ statistical expertise. EMH takes responsibility for the paper as a whole.
	Data sharing statement: A deidentified dataset and data dictionary are available upon request to Dr Hayden at emhayden@mgh.harvard.edu to investigators who provide an IRB letter of approval.
	All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors of the paper report no such relationships. The study did not receive any funding.