TY - JOUR
T1 - Outcomes Associated With Rural Emergency Department Provider-to-Provider Telehealth for Sepsis Care
T2 - A Multicenter Cohort Study
AU - Mohr, Nicholas M.
AU - Okoro, Uche
AU - Harland, Karisa K.
AU - Fuller, Brian M.
AU - Campbell, Kalyn
AU - Swanson, Morgan B.
AU - Wymore, Cole
AU - Faine, Brett
AU - Zepeski, Anne
AU - Parker, Edith A.
AU - Mack, Luke
AU - Bell, Amanda
AU - DeJong, Katie
AU - Mueller, Keith
AU - Chrischilles, Elizabeth
AU - Carpenter, Christopher R.
AU - Wallace, Kelli
AU - Jones, Michael P.
AU - Ward, Marcia M.
N1 - Funding Information:
The authors acknowledge Hannah McKay, MS, Mitchell Shaffer, BS, and Cathy Fairfield, RN, BSN for their assistance with data collection, Nathan Kramer, MPH, Paul Casella, MFA, and David Talan, MD, for their editorial assistance, and Steven Q. Simpson, MD for his assistance with study design. Author contributions: NMM and MMW conceived the study, secured research funding, conducted the study, and drafted the manuscript. UO, KKH, and MBS analyzed and interpreted the data and critically revised the manuscript for important intellectual content. BMF, AAP, KM, EC, and CRC contributed to the study design, interpreted the results, and critically revised the manuscript for important intellectual content. KC, CW, KW, BF, and AZ developed data collection tools, participated in data collection and validation, interpreted the results, and critically revised the manuscript for important intellectual content. LM, AB, and KD provided data access, and content expertise interpreted the results and critically revised the manuscript for important intellectual content. MPJ provided statistical consultation for the data analysis, interpreted the results, and critically revised the manuscript for important intellectual content. NMM takes responsibility for the paper as a whole. 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). This study was funded by the Agency for Healthcare Research and Quality (K08HS025753) and the Institute for Clinical and Translational Science at the University of Iowa through a grant from the National Center for Advancing Translational Sciences at the National Institutes of Health (UL1TR002537). NMM is additionally supported by funding from the Rural Telehealth Research Center with funding from the Health Resources and Services Administration (U3GRH40003). LM, AB, and KD are employed by an organization that provides commercial telemedicine services. These contents are solely the responsibility of the authors and do not necessarily reflect the views of the Agency for Healthcare Research and Quality and the official views of the NIH.
Funding Information:
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 ). This study was funded by the Agency for Healthcare Research and Quality (K08HS025753) and the Institute for Clinical and Translational Science at the University of Iowa through a grant from the National Center for Advancing Translational Sciences at the National Institutes of Health (UL1TR002537). NMM is additionally supported by funding from the Rural Telehealth Research Center with funding from the Health Resources and Services Administration (U3GRH40003). LM, AB, and KD are employed by an organization that provides commercial telemedicine services. These contents are solely the responsibility of the authors and do not necessarily reflect the views of the Agency for Healthcare Research and Quality and the official views of the NIH.
Publisher Copyright:
© 2022 American College of Emergency Physicians
PY - 2023/1
Y1 - 2023/1
N2 - Study objective: To test the hypothesis that provider-to-provider tele-emergency department care is associated with more 28-day hospital-free days and improved Surviving Sepsis Campaign (SSC) guideline adherence in rural emergency departments (EDs). Methods: Multicenter (n=23), propensity-matched, cohort study using medical records of patients with sepsis from rural hospitals in an established, on-demand, rural video tele-ED network in the upper Midwest between August 2016 and June 2019. The primary outcome was 28-day hospital-free days, with secondary outcomes of 28-day inhospital mortality and SSC guideline adherence. Results: A total of 1,191 patients were included in the analysis, with tele-ED used for 326 (27%). Tele-ED cases were more likely to be transferred to another hospital (88% versus 8%, difference 79%, 95% confidence interval [CI] 75% to 83%). After matching and regression adjustment, tele-ED cases did not have more 28-day hospital-free days (difference 0.07 days more for tele-ED, 95% CI −0.04 to 0.17) or 28-day inhospital mortality (adjusted odds ratio [aOR] 0.51, 95% CI 0.16 to 1.60). Adherence with both the SSC 3-hour bundle (aOR 0.59, 95% CI 0.28 to 1.22) and complete bundle (aOR 0.45, 95% CI 0.02 to 11.60) were similar. An a priori–defined subgroup of patients treated by advanced practice providers suggested that the mortality was lower in the cohort with tele-ED use (aOR 0.11, 95% CI 0.02 to 0.73) despite no significant difference in complete SSC bundle adherence (aOR 2.88, 95% CI 0.52 to 15.86). Conclusion: Rural emergency department patients treated with provider-to-provider tele-ED care in a mature network appear to have similar clinical outcomes to those treated without.
AB - Study objective: To test the hypothesis that provider-to-provider tele-emergency department care is associated with more 28-day hospital-free days and improved Surviving Sepsis Campaign (SSC) guideline adherence in rural emergency departments (EDs). Methods: Multicenter (n=23), propensity-matched, cohort study using medical records of patients with sepsis from rural hospitals in an established, on-demand, rural video tele-ED network in the upper Midwest between August 2016 and June 2019. The primary outcome was 28-day hospital-free days, with secondary outcomes of 28-day inhospital mortality and SSC guideline adherence. Results: A total of 1,191 patients were included in the analysis, with tele-ED used for 326 (27%). Tele-ED cases were more likely to be transferred to another hospital (88% versus 8%, difference 79%, 95% confidence interval [CI] 75% to 83%). After matching and regression adjustment, tele-ED cases did not have more 28-day hospital-free days (difference 0.07 days more for tele-ED, 95% CI −0.04 to 0.17) or 28-day inhospital mortality (adjusted odds ratio [aOR] 0.51, 95% CI 0.16 to 1.60). Adherence with both the SSC 3-hour bundle (aOR 0.59, 95% CI 0.28 to 1.22) and complete bundle (aOR 0.45, 95% CI 0.02 to 11.60) were similar. An a priori–defined subgroup of patients treated by advanced practice providers suggested that the mortality was lower in the cohort with tele-ED use (aOR 0.11, 95% CI 0.02 to 0.73) despite no significant difference in complete SSC bundle adherence (aOR 2.88, 95% CI 0.52 to 15.86). Conclusion: Rural emergency department patients treated with provider-to-provider tele-ED care in a mature network appear to have similar clinical outcomes to those treated without.
UR - http://www.scopus.com/inward/record.url?scp=85144594348&partnerID=8YFLogxK
U2 - 10.1016/j.annemergmed.2022.07.024
DO - 10.1016/j.annemergmed.2022.07.024
M3 - Article
C2 - 36253295
AN - SCOPUS:85144594348
SN - 0196-0644
VL - 81
SP - 1
EP - 13
JO - Annals of Emergency Medicine
JF - Annals of Emergency Medicine
IS - 1
ER -