Format

Send to

Choose Destination
J Epidemiol Community Health. 2019 Nov;73(11):1033-1039. doi: 10.1136/jech-2019-212623. Epub 2019 Sep 6.

Telemedicine is associated with rapid transfer and fewer involuntary holds among patients presenting with suicidal ideation in rural hospitals: a propensity matched cohort study.

Author information

1
Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA vakkalanka@healthcare.uiowa.edu.
2
Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA.
3
Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
4
Avera eCARE, Sioux Falls, South Dakota, USA.
5
Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
6
Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA.
7
Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.

Abstract

OBJECTIVE:

The purpose of this study was to evaluate the impact of telemedicine in clinical management and patient outcomes of patients presenting to rural critical access hospital emergency departments (EDs) with suicidal ideation or attempt.

METHODS:

Retrospective propensity-matched cohort study of patients treated for suicidal attempt and ideation in 13 rural critical access hospital EDs participating in a telemedicine network. Patients for whom telemedicine was used were matched 1:1 to those who did not have telemedicine as an exposure (n=139 TM+, n=139 TM-) using optimal matching of propensity scores based on administrative data. Our primary outcome was ED length-of-stay (LOS), and secondary outcomes included admission proportion, use of chemical or physical restraint, 30 day ED return, involuntary detention orders, treatment/follow-up plan and 6-month mortality. Analyses for multivariable models were conducted using conditional linear and logistic regression clustered on matched pairs with purposeful selection of covariates.

RESULTS:

Mean ED LOS was not associated with telemedicine consultation among all patients, but was associated with a 29.3% decrease in transferred patients (95% CI 11.1 to 47.5). The adjusted odds of hospital admission (either local or through transfer) was 2.35 (95% CI 1.10 to 5.00) times greater among TM+ patients compared with TM- patients. Involuntary hold placement was lower in those exposed to telemedicine (adjusted odds ratio (aOR): 0.48; 95% CI 0.23 to 0.97). We did not observe significant differences in other outcomes.

CONCLUSION:

The role of telemedicine in influencing access, quality and efficiency of care in underserved rural hospitals is critically important as these networks become more prevalent in rural healthcare environments.

KEYWORDS:

Emergency Service, Hospital; Patient Outcome Assessment; Rural Health Services; Suicide; Telemedicine

PMID:
31492762
DOI:
10.1136/jech-2019-212623

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center